In patients undergoing conservative therapy for T1G3 disease, the evidence suggests the need for a repeat TUR and appropriate imaging to ensure that the tumor is adequately staged. If pathology demonstrates T1G3 disease in the absence of other high-risk features (noted above), intravesical therapy with induction and maintenance BCG are essential to decrease the risk of recurrence and progression. The use of maintenance therapy varies across published reports and practices, but we adhere to the “6 + 3” BCG regimen outlined in the SWOG 8507 study (also known as the “Lamm regimen”). The patient needs to be counseled on a roughly 30% probability of no progression or recurrence with the 30% risk of requiring a cystectomy due to progression of disease before committing to conservative therapy. Conversely, the patient should consider that immediate cystectomy can result in five-year disease-specific survival greater than 90% but at the expense of living with a urinary diversion.