Well I had the last BCG (#6) treatment for round one, this Friday. I have a cysto scheduled for the second week of Aug. So, I have been doing a great deal of reading, to prepare myself, in case the cancer returns, and in case it's worse than last time.
So what is your opinion of the below data. It seems to favor, non-invasive treatment VS Rc?
Bladder Cancer Surgery
“Radical cystectomy has come to be the preferred method of treatment primarily because of the strong possibility of recurrence. While this is logical in theory, clinical experience
tells another story, and one which is considerably less clear-cut. It is true that radical cystectomy can reduce the local recurrence rate drastically, from around 70 percent down
to 10 percent, but, surprisingly, even though the recurrence rate can be cut so dramatically using radical cystectomy, radical cystectomy has not been shown to offer a clear survival advantage over less drastic methods of treatment.
In a classical study during the late 1980s, a group of patients who had had their bladder cancers excised using solely trans-urethral resection (TUR) were followed over a sevenyear period. During that time, 70 percent of the patients developed recurrences. Two thirds of the patients who suffered recurrences were operated on again with a repeat TUR, and continued to do well during the follow-up period. The other third of the
patients who suffered a recurrence underwent cystectomies. One third of these patients died during the follow-up period. The surprising finding was that the overall disease-free survival of the patients in this study was just over 80 percent.
The same researchers who conducted this study later went on to carry out another study in the mid-1990s, this time reviewing the experience of a number of urologists who were treating suitable bladder cancers with TUR only. The five-year survival rate for TUR treated patients with cancers that were deeply muscle-wall-invasive was 57 percent; for those with similar cancer who were treated by radical cystectomy it was 60 percent. The conclusion they drew from these figures was that TUR was as effective as radical cystectomy.
In another study, this time reviewing the long-term outcome of partial cystectomy, although 60 percent of the patients reviewed had subsequently developed a recurrence, all but 8 percent of these patients had their recurrences treated by local measures (TUR, fulguration). The remaining 8 percent required more invasive surgery (i.e., cystectomy)to control their recurrences.
The conclusion to be drawn fromthese various studies is that in many cases close and vigilant follow-up, rather than radical initial surgery, may offer the best possible chance of survival. Given that local recurrence is a strong possibility, early detection and prompt treatment of such recurrences provides the best chance for long-term health.
Of course, there is merit to the argument that initial radical cystectomy may obviate the need for repeat interventions. But if a patient is willing to accept the probability that repeat interventions will be necessary, bladder-sparing surgery is a good choice and one that will not compromise the prospects for survival.