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CIS Remains After 6-Wk BCG Induction

3 years 5 days ago #51796 by Jack R
Mike,
I am a bit ahead of you on this path. I offer two articles as a starting point toward (MY) making an informed but questionable decision.

I had a hard facts discussion with the doc, including the nuances of the biopsy results (first clear, then new or remaining CIS) about how long to try to save the bladder before going the RC route. My concerns include the high percent of RC's that prove invasive when examined after removal. My desire is treat as long as the (presumed) chance of undetected invasion is low.

Based on much journal research and, most importantly, the findings in MY situation, I chose to go for a second course of BCG with follow ups. I am two months away from the next scope, CT and TURBT, which will either make the next decision easy or restart the risk assessment of how long to treat.

Tough decision with a lack of authoritative research applicable at the individual level.

Best
Jack
Can Urol Assoc J. 2009 Dec; 3(6 Suppl 4): S199–S205.
PMCID: PMC2792453
The management of BCG failure in non-muscle-invasive bladder cancer: an update

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792453/

Adv Urol. 2015; 2015: 656918.
Published online 2015 Oct 13. doi: 10.1155/2015/656918
PMCID: PMC4621325
The Role of Interferon in the Management of BCG Refractory Nonmuscle Invasive Bladder Cancer
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621325/

What's with this Bleeding ? 6/2015
DX: HG Papillary & CIS
3 Years and 30 BCG/BCG+Inf
Tis CIS comes back.
BC clear as of 5/17 !
RCC found in my one (only) kidney 10/17
Begin Chemo; Cisplatin and Gemzar
8/18 begin Chemo , round 3
Begin year 4 with cis
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3 years 5 days ago #51795 by sara.anne
Mike, this is one to have a serious discussion with your urologist, no holds barred. You need to know all the pros and cons of any approach. You also might want to seek a second opinion at a place that does a LOT of bladder cancer treatment, if you aren't already at one.

Sometimes BCG is continued for a while, often with interferon added. However, CIS is not something to fool around with.

So sorry to hear this.

Wishing you all the best

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
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3 years 5 days ago #51794 by Mike M
Hey Friends,
Just got the pathology results from my first BCG follow-up cystoscopy and biopsies last week. Two biopsies were benign but the third biopsy in the trigone area was diagnosed at "Focal carcinoma in-situ in a background of urothelial dysplasia. Detrusor muscle present. Negative for invasive carcinoma."

So my question is since the CIS has remained in one spot after my initial 6-wk BCG induction course (finished in Apr), should I go for another 6-wk BCG induction or is it time for the RC? I thought per Dr Lamm, you needed to allow BCG to work for 6 months before declaring failure. Since I finished in Apr, shouldn't I wait until Oct to see if I completely respond to the BCG or am I playing with fire? Anyone been in a similar scenario where CIS remained and BCG was continued?

Thanks!

12/15 - Diagnosed Ta HG, 1.5cm Pap, Focal CIS
3/16 - Began BCG following NCCN and SWOG guidelines
2/19 - Ta HG recurrence and CIS/Ta HG in right kidney/ureter
2/19 - Nephroureterectomy to remove right kidney/ureter
6/19 - BCG x 30 completed

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