If correct, it looks and sounds and smells like progression, though it's certainly good news that your high grade is apparently not CIS. High grade blc needs to be watched very carefully, whether TaG3 or T1G3 or CIS. Not to scare you, but understaging of blc can be an issue for some, so I'll suggest a couple of things.
First, BCG induction and maintenance is definitely called for. And you might consider getting FISH and the UV cystoscopy done, also (in addition to cytology).
FISH, though controversial, is considered by some to be an early indicator of recurrence. My uro at Stanford refused to do FISH, so I flew out to MD Anderson to get it done. Always had negative results, which gave me some peace of mind.
Visible light cystoscopy is not the most thorough way to find cancer. You can read more at the link below about hexvix. MD Anderson had a trial unit there three years ago, maybe others can tell you who else has one.
Cytology and visible light cystoscopy are the gold standards of detection for recurrent high grade cancer, but they aren't perfect. Hence my suggestions (only because I'm a bit paranoid <g>).
Dx 7/04, CIS + T1G3, Age 50
Cystectomy 8/05 USC/Norris
So far, so good (kow)
As I wrote recently under the "Ta Grade 3 Questions" topic, I was diagnosed with high grade superficial urothelial carcinoma in July 2007. This was a recurrence, as I had Ta Grade 1 in 1998 and Ta Grade 2 in 2000.
I rode a roller coaster of "it's high grade" "no, it's low grade" "no, it IS high grade" as I sought second and third pathology opinions. I have since had a CT scan, which looked good. I also had biospies done in the O.R. so that the lamina propria and muscle could be represented in the specimen. The results: high grade carcinoma was seen in the specimen of the area where the tumor was removed in the office (though my original urologist thought he had got it all), and the cancer was staged Ta -- no invasion. The cytology was negative.
The next step is to have BCG + maintenance. That would be 6 treatments initially, then three treatments every 3 months after that for a total of 15 treatments.