Non-muscle invasive bladder cancer (NMIBC) makes up about 75% of all bladder cancers. Unfortunately, the majority of patients with NMIBC will experience a disease recurrence and a substantial proportion of them (~20–25%) will progress to muscle-invasive disease. Patients with high-risk NMIBC represent a particularly challenging patient group that is confronted with an increased 5-year risk of recurrence (up to 80 %) and progression (up to 50 %).1 At BMUC 2020, an entire session was dedicated to the different treatment options for these patients: Dr. Tim Muilwijk (University Hospitals Leuven, Leuven, Belgium) discussed BCG therapy, Prof. Dr. Joan Palou Redorta (Fundació Puigvert, Barcelona, Spain) talked about the potential of early cytoreductive therapy, Prof. Dr. Anthony Zietman (Massachusetts General Hospital, Boston, USA) made a case for the use of radiotherapy in high-risk NMIBC patients and Prof. Dr. Yohann Loriot (Gustave Roussy Cancer Campus, Paris, France) provided an overview of the data generated with targeted therapy in this setting.