The Folie à Trois

A 90-year-old man (World Health Organization performance status 1) presents with a T3N0M0 muscle-invasive bladder cancer on the right anterolateral bladder wall (Fig. 1). The diagnosis was obtained with needle biopsy rather than transurethral resection of the bladder, and gross disease was left behind. The surgeon is reluctant to take to theater, even for a repeat transurethral resection of the bladder. The patient had previously had prostate external beam radiation therapy to 72 Gy in 2001 with a 4-field block, based on a cystourethrogram and barium in rectum.

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