Hi again Nancy,
Mitomycin or any other intravesical chemo is considered less effective for CIS than BCG is. The new guidelines in Europe and the USA state that the best time to have mitomycin or another chemo drug instilled in the bladder is within 24 hours of the TUR, to delay recurs; this is being done now whether BCG is planned or not. Although it's becoming standard, it takes years for these changes to trickle down, so I wouldn't be surprised or upset if your doctor didn't follow it.
State of the art info on the subject say that administering a buffer (I think it's done by drinking sodium bicarbonate) and draining the urine increase the effectiveness of the treatment:
blcwebcafe.org/mitomycinprotocol.asp
, and this simple innovation can be applied to whatever chemo drug gets instilled. I heard an expert say it may be the most important aspect of giving intravesical chemo, more important than which drug is used or how long it's held!
Believe it or not, it isn't considered a failure if someone has a recur a year after BCG, and treatment is usually given again or with the addition of Interferon. If CIS is present at the dx, then maintenance BCG or BCG+IFN is added to the 6 rounds. You can read up on it under 'treatment options: immunotherapy' on WebCafe.
There's a ton of studies comparing Mito to BCG, all of them say the two treatments are about equal...except in case of CIS-then immuontherapy is proven to be more effective. And it's now known that only BCG can prevent progression of stage with high grade blc (about 75% of the time), while the chemo drugs only delay recurrences but work better for lower grade cancer.
If you need articles on the subject I'm sure I have some stored.
I'm sure that the second path opinion from Johns Hopkins will help you and your uro decide on the best path, are you getting a second opinion on treatment options as well?
Wendy