Thanks for sharing the detail pathology report.
So, your tumor is TaHG. The tumor is in the first layer - epithelial tissue of the bladder wall. It has not progressed to the next tissue (connective tissue / Lamina propria). The specimen included muscle tissue ( Detrusor muscle) but found not tumor. So, it has not progressed to muscle tissue. Because it was a solitary tumor and less than 3 cm. Your tumor is classified intermediate risk.
AUA guidelines says
- In an intermediate-risk patient a clinician should consider administration of a six week course of induction intravesical chemotherapy or immunotherapy. (Moderate Recommendation; Evidence Strength: Grade
- In an intermediate-risk patient who completely responds to an induction course of intravesical chemotherapy, a clinician may utilize maintenance therapy. (Conditional Recommendation; Evidence Strength: Grade C.
- In an intermediate-risk patient who completely responds to induction BCG, a clinician should consider maintenance BCG for one year, as tolerated. (Moderate Recommendation; Evidence Strength: Grade C)
I think your urologist did a good TURBT as the specimen included muscle tissue, which follows AUA guideline.
I was diagnosed as TaG2. Before G1,G2,G3 were and still be used often in Europe, then WHO changed it to LG, HG. So,, a part of G2 is now classified as LG and the opposite scale of G2 is now HG. My urologist chose TURBT, 4 months later, another biopsy to see anything is found. In my case, nothing was found, so he put me on surveillance by regular cystoscopy only. I asked him one day why he did not take biopsy from muscle tissue as my pathology report said muscle tissue was not included in the first TURBT. He said he did not do it because my tumor was not even in the connective tissue. I have noticed that he does not follow the guideline line by line, but he has over 30 years of experience. Anyway, I have not had recurrence for 5 years. I mentioned my experience as to see if you should go to another hospital who has BCG rather than wait without knowing when you will get it. TaHG is intermediate risk by the guideline, but it depends upon how high your HG is. Below chart shows recurrence free for T1G2, G3. With intravesical BCG therapy, the recurrence free survival was the best for G2,G3 (black line). It seems to make more sense to look for BCG rather than doing frequent cystoscopy to find out if there is recurrence. My concern is propensity of progression of your HG tumor. 50% of HG are known to progress without proper treatment. Some patients faced with BCG shortage phone around other hospitals to see if they have BCG. Sometimes urologist call other hospitals and borrow BCG. In case intravesical chemotherapy is chosen, use Gemcitabine + Docetaxel sequential treatment as recent study by Iowa University team reported very good result for BCG naive patients. I know often community hospitals do not provide GEM/DOC treatment as it takes three hours instead of 30 min for BCG and it requires training, but most academic hospitals should be able to do GEM/DOC.