Seth P. Lerner, MD, Professor of Urology and Vicechair for Faculty Affairs in the Scott Department of Urology, and Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program at Baylor College of Medicine, discusses the optimal therapy for T1 highgrade (T1HG) bladder cancer. He considers the potential for enhancements in treatment, especially in Bacillus CalmetteGuerin (BCG) unresponsive patients.