Though different urologists may have developed their own regimens for the treatment of non-muscle-invasive bladder cancer (NMIBC), I think the protocol which your urologist uses is not the current protocol many urologists use for high-risk non-muscle-invasive bladder cancer (NMIBC). Note that any HG is considered as high risk except for a single tumor with TaHG which is less than 3 cm. In your case, there are 3 tumors and T1, so it is classified as high-risk NMIBC.
Around 2015, FDA and prominent urologists/researchers who focus on bladder cancer came to a consensus on the definition of adequate BCG treatment. They came up with a new classification - BCG non-responsive when there is a recurrence of high-risk NMIBC after adequate BCG treatment was given. The adequate BCG treatment is defined as the induction course of at least 5 BCG treatments plus the minimum of a maintenance course with at least two BCG treatments. One of the reasons for defining the adequate BCG treatment to include the induction and at least one course of the maintenance is because the maintenance has shown improved the complete response rate for high-risk NMIBC which improved from about 50% complete response rate after the 6 weeks induction course only till above 80% after the completion of the first 3 weeks maintenance treatment. Also, the induction + maintenance clearly show better results for T1HG. (Dr. Ashish Kamat of MD Andersons )
Dr. Kamat explains the advantage of 3 weeks maintenance every 3-6 months protocol over other protocols in his presentation.
Watch from 10:00
Another advantage in following the widely accepted protocol is most current and future studies of NMIBC will use the BCG non-responsive as the base for researches and drug development. A case in point is FDA approval of Pembrolizumab (Keytruda by MERCK) immunotherapy use for those who do not respond to BCG treatment. The clinical trial in which the FDA approved the use of Keytruda only included those NMBIC patients who had recurrence after the initial induction (5-6 weekly treatments) and at least the first maintenance course (2-3 weekly treatments). Insurance companies usually have to cover for FDA-approved treatment but not if the patient does not meet the inclusion criteria of the clinical trial, for only BCG non-responsive NMBIC patients - those who had adequate BCG treatment ( induction course and at least the first maintenance course). The concern I have is that if the protocol which your urologist uses such that 6 weeks induction course and puts you on surveillance by cystoscopy, then follow with another BCG only if a recurrence happens may prevent you from receiving the Keytruda immunotherapy treatment. This is something you may want to discuss with your urologist.
Another example of the new drug for high-risk NMBIC is Vicineum by Sesen Bio. Recently FDA accepted for filing the Company’s Biologics License Application (BLA) for
Vicineum for the treatment of high-risk, BCG-unresponsive non-muscle invasive bladder cancer (NMIBC), and granted the application Priority Review
ir.sesenbio.com/news-releases/news-release-details/sesen-bio-announces-fda-acceptance-and-priority-review-its
Recently, the result of a study on high-risk NMIBC in the US VA health care system was published. Though the study was to find out the cost of the treatment. It showed those who received adequate BCG treatment ( at least 5 weeks induction course + at least 2 weeks maintenance course) had better results than those who had induction-only BCG treatment.
" A total of 392 patients (95%) received adequate induction BCG therapy, and 152 (37%) received adequate BCG therapy. For all patients with high-risk NMIBC, the 10-year progression-free survival rate and disease-specific death rate were 78% and 92%, respectively"
www.practiceupdate.com/content/costs-and-long-term-outcomes-of-high-risk-non-muscle-invasive-bladder-cancer-treated-with-bacillus-calmette-guerin/116647/21/25/1
As noted in the above examples. having the induction + the maintenance (adequate treatment) not only has shown higher efficacy over the induction only treatment but also pharmaceutical industries and bladder cancer research communities are already basing their drug development and researches on the criteria that the patients have the adequate BCG treatment, which is the induction + the maintenance.
You may not have a recurrence after the 6-week induction course, so what have I described above may become irrelevant, which I hope will be your case.
best