Superficial bladder cancer (Stage Ta-T1) will commonly recur but will progress to invasive, life-threatening disease in only about 15% of patients. Since recurrence may occur at any time after initial detection of a tumor, life-long surveillance is recommended for most patients. This surveillance is at least initially provided every three months. Recent work looking at molecular markers (sophisticated tests on tumors) may help to identify a subset of patients who do not need life-long surveillance. Since superficial tumors affect the lining of the bladder (urothelium), it is possible for other areas of the urothelium (kidneys, ureters, urethra, prostatic segment of urethra) to develop tumors. These areas are much less likely to develop tumors (2-25% risk), but still need to be surveilled with X-ray tests or ureteroscopy on a regular basis (usually once a year.)

More aggressive tumors may present as carcinoma-in-situ. Although only the lining of the urothelium is affected (Stage TIS), these tumors may progress very rapidly to invasive or metastatic tumors if they are not effectively treated by intravesical chemotherapy/immunotherapy (chemotherapy or BCG/interferon treatments placed directly into the bladder using a catheter.)

Invasive bladder cancer is likely to recur with aggressive local tumors in other areas of the bladder, even if the initial tumor is effectively removed through the urine passage (transurethral resection) or partial removal of the affected part of the bladder (partial cystectomy.) Complete removal of the bladder is usually recommended. Up to 25% of these patients will later develop tumors in the kidneys, affecting the urothelium of the renal pelvis or ureter, so ongoing surveillance is important.

Untreated, bladder cancer that has spread beyond the pelvis (metastatic bladder cancer) is often rapidly progressive and usually is a fatal process. Effective treatment may require intensive chemotherapy.