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Low grade and BCG treatments
Posted by Eight15 on February 6, 2018 at 11:18 pmHas anyone else had BCG for low grade bc? If so, how did it work for you?
My history:
8/2015 1- LG superficial tumor
4/2017 2- LG superficial
12/2017 1- LG superficial
1//2018 start BCGsara.anne replied 7 years ago 5 Members · 12 Replies -
12 Replies
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Yes, Joanne….. “papillary urothelial neoplasm of low malignant potential” is medical-speak for low grade bladder cancer. Since it has returned, BCG is what is indicated.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum ModeratorSara Anne,
I requested a copy of my pathology report. The report states “papillary urothelial neoplasm of low malignant potential.” My doctor said the LGBC returned… is that the case? I am scheduled to start a series of 3 BCG treatments tomorrow, Can you or anyone give me your thoughts on this?
Confused – JoanneLow grade does pose problems on how to treat it. There is no medical contraindication for using BCG in these cases, EXCEPT that it isn’t wonderfully effective and it does have some side effects. Also, the side effects are cumulative so
many docs don’t want to use it prematurely since it might make it harder for the patient to tolerate when it might really be needed. Since low grade can be monitored by frequent cystoscopy, and since it might (hopefully) never return, many urologists wait on the BCG. If the low grade DOES return, then the “big guns” of BCG are used.Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum ModeratorHi Sue Ann,
Yes it was low grade the first time too. I am basically starting over. I am 46 years old and my doctor is being proactive, is what he told me. I haven’t seen that BCG is contraindicated with low grade… is it? I am definitely worried and am going to ask for my pathology report when I go on Tuesday. I have quite a few questions for my doctor. I’m still putting my faith in God though. Prayers are appreciated. I will continue to keep you all in my prayers as well.
JoanneJack,
Just want to say thanks for all of the information. I have a lot of homework to do! You are a wealth of knowledge and very generous with your time. The forum is lucky to have you!
Eight15,
Guidelines are just that – guidelines. The patient, history and treating physician must all be primary in the decision-making process of how to treat an individual.
Guidelines and expert consensus opinion are medicine’s way of describing treatment paths that have been shown to produce repeatable outcomes for SOME portion of the [inadequately] described patient population. That outcome is NOT promised for any individual patient; the guidelines are just a starting point for the consideration of individual treatment options.
As you dig deeper into the works of Dr Donald Lamm and Dr. Mike O’donnell and others, factors such as “how soon LG tumours return” becomes a factor in decision making. The search for biomarkers that might identify those patients at risk for grade advancement are ongoing, and would be a much welcomed discovery.
At about page 13 of the consensus document the long term results of a variety of BCG schedules are discussed and displayed graphically. Although there is debate about the schedules, there are scant actual long term studies published that are conclusive.
Fortunately, we have doctors and care teams to guide us in our battle with BC. If all we had were guideline-driven treatment, some portion of us would likely receive far less than appropriate care.
Other consensus documents exist. The American Urological association and the Canadian Urological Association publish their own. These version dig deeper and evaluate the level of the underlying evidence. And there are thousands of single author publications. Below are links to the two additional association source documents.
http://www.auanet.org/guidelines/non-muscle-invasive-bladder-cancer-(aua/suo-joint-guideline-2016).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771569/
Yes, I have read too much these past 3 years.
Best,
Jack
6/2015 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# 3
Begin year 4 with cis
2/19 Chemo #4
9/19 NED again :)
1/2020 CIS is back
Tried Keytruda, stopped by side effects
Workin on a new plan for 2021Hi Jack,
Thank you for your reply and for providing me with that most informative website link. From what I gather, as this pertains to my situation, the expert guidelines for low grade recurrent bc is optional for the use of BCG. So I guess it’s up to to Dr and the patients personal situation.
It’s often written in this forum and others about how LG bc doesn’t respond well to BCG, but I haven’t found any info/studies regarding that. I know the guidelines suggest that it’s optional, but it doesn’t state anything about how effective it is.
Do you (or anyone reading this) know of any studies that would show stats as to outcomes for patients with low grade recurrent bc after being treated with BCG.
Thanks so much for your help!
Eight15,
Since I have the answer at at hand,
Regarding BCG and Low Grade Tumours, the following article is a good starting point.
‘Expert consensus document: Consensus statement on best practice management regarding the use of intravesical immunotherapy with BCG for bladder cancer’
From, Nature Reviews Urology volume12, pages 225–235(2015)
Beginning on (about page 6) under the section header,
“Review of current guidelines on BCG use”
See the BCG recommendations for various initial presentations.
From the text, “Consensus exists for small, solitary, superficial low-grade tumours (Ta) with all groups agreeing that BCG is not indicated in this setting given the very low risk of disease progression.”
The entire article discusses specific aspects of BCG decision making, and the contributor list includes well credentialed major researchers and clinicians.
Extensive footnotes provide further information and resources.
Full Article at:
http://www.nature.com/nrurol/journal/v12/n4/full/nrurol.2015.58.htmlALWAYS verify ANY recommendation or information from a publication or the internet with YOUR care team who knows YOUR situation. One size does not fit all.
Best,
Jack
6/2015 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# 3
Begin year 4 with cis
2/19 Chemo #4
9/19 NED again :)
1/2020 CIS is back
Tried Keytruda, stopped by side effects
Workin on a new plan for 2021Hi Sara.anne, I’ve often heard that BCG isn’t as effective on low grade bc, but can’t find any real medical info on this subject. I only hear this on message boards and have not heard any doctors state this. Can you, or anyone reading this, provide any details on studies/medical articles that confirm this? I was told by my urologist that it works well for recurrent bc. I’m about to have my 4th bcg treatment. Thanks so much!
Joanne, what was the pathology of the first tumor? Was it low grade? BCG has been shown not to be as effective with low grade bladder cancer as it is with high grade. Low grade bladder cancer is usually treated by watchful waiting (cystoscopy every three months) and BCG is only used if the low grade keeps returning. Since yours has returned, BCG is indicated. But I just wondered if it was low grade at the beginning?
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum ModeratorI was diagnosed with low grade superficial bladder cancer in Sept 2016. I had a somewhat small tumor removed, 1 dose of mitromician and 6 BCG treatments. I had a cystoscope every 3 months. In Nov 2017 my doctor found 3 small spots. In Dec 2017 I had those low grade spots removed. I begin a 3 course round of BCG on Feb 13. My doctor said this was not a BCG failure because it was still low grade. This was tough to swallow. I thank God I have a good doctor who found it and is pro active. I wish you luck with your treatments. Please keep us updated.
JoanneNo but I’m interested in knowing because I might be going this route, just had my second TURB’s follow up pathology appt post poned from this afternoon until next Tuesday.
So I’ll find out then if the results suggest BCG, or what. But I could very well be in the same or similar boat as you. So I am curious to find out more as well.
Heavy Wine Hematuria: 7/28/2017
Original DX: LG/NMIBC 1.7×1.5x2cm
1st TURB on 9/12/17
1st Pathology Results on 9/25/17
1st Scope Recheck on 1/12/18
2nd TURB on 1/23/18
2nd Pathology on February 2/13/18 (TBD)Sign In to reply.
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