The “Dirty Harry” Approach

Clinical decisions around this case (1) hinge on the intent of treatment. The reluctance to operate implies significant comorbidity or frailty, calling into question this individual's tolerance of radical therapy, and the inability to achieve a complete transurethral resection of bladder tumor predicts suboptimal outcomes with curative approaches (2). The prior pelvic radiation therapy raises the spectre of significant cumulative radiation toxicity. With these factors in mind, a therapeutic plan should heed Dirty Harry's advice: "A man's got to know his limitations."

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