Jeffrey M. Holzbeierlein, MD, Director of the Division of Urologic Oncology at the University of Kansas Hospital and Director of Clinical Research for the Urology Department at KUMC, talks about how to manage highgrade T1 bladder cancer (HGT1BC). He discusses 5year progression rates of HGT1BC, pathological substratification of the disease, and risk calculators to estimate patient progression. Dr. Holzbeierlein concludes by discussing enhanced cystoscopy, the value of reresection, and the importance of bacillus CalmetteGuerin (BCG) maintenance in HGT1BC.