Detection of these mutations in 60% of CIS cases indicates that they likely represent a common and early occurrence in the pathogenesis of both NMIBC and MIBC [13]. Although mutations in the TERT promoter represent an early event in the onset of bladder cancer, its promoter hypermethylation appears to be a more dynamic process involved in the advancement of the disease. Here, TERT is linked to in situ carcinoma.