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Study Type – Therapy (individual cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Although it has been reported that patients with primary carcinoma in situ of the bladder (CIS) have a better prognosis than patients with concomitant or secondary CIS, the risk profiles of these three clinical types of CIS have not yet been fully clarified. The current study was performed to give further insight into the risk profiles of these three clinical types of CIS. In clinical practice it would be helpful to be able to discriminate ‘high‐risk’ from ‘low‐risk’ CIS before the start of intravesical therapy and as such to tailor the treatment and follow‐up to this risk‐profile. OBJECTIVE • To further clarify the risk profiles of three clinical types of carcinoma in situ (CIS) of the bladder. MATERIALS AND METHODS • Population‐based data from the Comprehensive Cancer Centre Middle Netherlands, as part of the nationwide Netherlands Cancer Registry, were used for patients presenting with CIS in the period from 1987 to 2009. • Patients with muscle‐invasive bladder cancer on primary diagnosis were excluded. The patients were divided into three groups according to their ‘clinical type’, being primary, concomitant or secondary CIS. RESULTS • Overall, 90 patients with CIS were identified with a mean age of 63.4 years, predominantly men (91.1%). Primary CIS (P‐CIS) was found in 43 patients (47.8%), concomitant CIS (C‐CIS) in 21 patients (23.3%) and secondary CIS (S‐CIS) in 26 patients (28.9%). Mean follow up was 81.3 months (range 8–222 months). Recurrence of disease was observed in 68.9% of patients, with significantly more recurrences in the S‐CIS group (88.5%). • Progression to muscle‐invasive disease was seen in 17 patients (18.9%): eight patients (18.7%) with P‐CIS, four (19.0%) with C‐CIS and five (19.2%) with S‐CIS. Overall, 29 patients underwent a cystectomy, equally distributed over the three groups. The duration of bladder preservation was worse in the C‐CIS group but did not differ significantly between the groups. • Overall survival at 5 years was 79.6% for the total group, with poorer results for the C‐CIS group, although the difference was not significant. CONCLUSIONS • Carcinoma in situ is clearly an entity that requires meticulous treatment and thorough follow up because of its high recurrence rate (68.9%) and high rate of progression to muscle‐invasive bladder cancer (18.9%). • The C‐CIS group appears to have a poorer prognosis with a shorter duration of bladder preservation and a worse overall survival.