I write from Italy and I need your help.
My father (who is 70 years old) discovered a bladder cancer at the end of this August. He immediatly had a TURP on the 6th of September and the results underlined a papilloma and a cis (infiltrating the corion but not the muscle). I can come back with more details concerning this result but I am not sure I can translate everything into English. Now our dubts concern how to go on. The doctor who has operated him suggested to star the 14th of October with the BCG (6 treatments once a week, then tow weeks stop, the other treatments and the maintaining for 36 months). He suggests to start immediatly with the BCG and then in three months to see if another TURP is needed.
To have another point of view we contacted also another doctor but this one disagrees and suggests another TURP at the end of October and then the BCG.
Now we are very confused: who is right? which is the correct protocol?
the first doctor, the one who operated, tells he is sure to have removed everything and for him is better not to wait for the BCG therapy. The other one thinks that often with the first TURP you do not remove everything and so he wants another TURP.
can you please tell me what do you thing?
Thank you for your help.
Well you have done the right thing by getting a second opinion. In the states it is recommended to do a second TURP from 2 to 6 weeks after the first. It may be that the first surgeon did get all of the tumor and margins but a second look is the way to go here as it is estimated that 50% and higher are understaged. The BCG is the route to go but you should wait until the bladder is healed and that is about 3 weeks after the TURP.
In what region of Italy are you located?
I do not know where your first TURP was done? In a University hospital? There are several that are tops in urology so it may very well be that the first surgeon did get it all but do your homework. Its important also that the pathology department is a top notch center.
By the way here is a free translation site....... www.freetranslation.com/translate-english-italian.htm
Thank you very much Patricia for coming back to me. we are so confused and we do not know the way to choose.
We are from Milan and the second doctor, the one who suggested the second TURB is from IEO which is considered an excellence center for cancer in Italy.
My worries refer to the time we need to wait for starting BCG after the second TURB. In fact in Italy the do not repeat TURB prior than 4-6 weeks and the do not start BCG before 4-6 weeks from the TURB: very different from what you tell me about USA.
I read everywhere that CIS goes very fast. Is not too much time to wait for BCG treatment?
on the other side if the cancer is understaged and is infiltrating the muscle I understand BCG is not useful at all. Is it correct?
Here is a great paper written on the European Guidelines for a second TURB....its also what we recommend in the states. www.europeanurology.com/article/S0302-2838(10)00367-2/fulltext
As for IEO its a bit confusing as the urologists listed are from USC/Norris...in Los Angeles...Drs. Skinner and Boyd..very well known uro/surgeons in the bladder cancer field.
You want someone who sees a lot of bladder cancer...its an elusive and not very well studied cancer....Most urologists concentrate on the Prostate or other problems. CIS is considered high grade and often BCG will eliminate it...but if it comes back you want to make sure you are with a very experienced surgeon who really knows what he is doing.
Generally the wait is around 3 to 4 weeks after TURB..enough time for the bladder to heal from the TURB before BCG is administered. Dr. Lamm pioneered the protocol for BCG www.blcwebcafe.org/drlammsprotocol.asp
Thank you very much Pat for your help.
I cannot understand one thing: do you mean IEO is the correct place or not?
perhaps can I contact some USA bladder cancer experts who can suggest me where to go in Italy? what do you think about?
Thank you again.
Wish i knew more about Milan. I will ask my surgeon at USC/Norris if he has a recommendation and get back to you. I did notice a San Raffaele Hospital in Milan that had a experienced urological team..a Dr. Cestari. Its difficult for me to translate the other way around. Terrible since i'm Italian but only took a crash course in it about 25 yrs ago. Can read most of it but can't write it.