I was diagnosed with noninvasive but high grade april 1, 2011 after TURBT performed March 30 by highly regarded private urologist. He said the tumor had been there for "a long time." He did Mitomycin C treatment and scheduled course of 6 BCG treatments to begin April 20,2011. Two pathologists (one at major cancer center) concurred with noninvasive high grade per slides. Second opinion surgeon at MD Anderson recommends putting off the scheduled BCG treatments and going to MD Anderson week of May 24 for second TUR for restaging. I have read the MSK study on RETUR and comments on this forum that the second TUR is "gold standard" for high grade and I am inclined to follow advice of MD Anderson surgeon. Should I be concerned about delaying the BCG treatments, effectively doing nothing until the RETUR in the end of May? Should the RETUR have been suggested by my urologist even though he "aggressively" scraped more than 30% of my bladder and got margins, etc? I did note that in the MSK full article about restaging TUR the author said that getting good margins, etc on the first TUR could potentially take the place of the 2nd TUR. I am ready to go to MD Anderson if needed. I appreciate any input.
Thank you so much,
very scared and confused
I don't think the delay in BCG is a major factor for you to consider. Many studies have shown that a second TURB often finds things that were missed in the first. It is not due to incompetence, but more to the fact that the second time the urologist has a better idea of what is there and what he/she is looking for. It would be better to have a truly clear idea of the situation before treatment begins.
MD Anderson is a true center for bladder cancer. If it is not a terrible inconvenience for you, it might be a really good idea to go there and see what their result/diagnosis and treatment plan would be after the second TURB. Then you can decide whether to go on with the BCG with your local uro or continue with whatever MDA might recommend.
Good luck to you!!!
Sara Anne (whose second TURB found a much more serious situation than the first)
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Hello and welcome to the site. I'm sorry about your recent diagnosis but you certainly have come up to speed in a hurry. I cannot comment on the BCG because I have not had that treatment, but MD Anderson seems to be a good choice to confirm your diagnosis and get their recommendations for treatment. If it is a distance for you to travel, perhaps you could even do your treatments locally since you have confidence in your current uro once a protocol is established.
It just seems that when dealing with this BC beast, the higher volume centers are the place to go to ensure the best care. MD Anderson is clearly in that category.
Best wishes for the best possible outcome. I'm sure others will chime in with their BCG experiences.
Best wishes... Catherine
Forum Moderator Team
TURBT 1/21/10 at age 55
Dx: T2aN0M0 Primary Bladder Adenocarcinoma
Partial Cystectomy 2/25/10
Vanderbilt Medical Center
Welcome and sorry about your diagnosis. I would be inclined to follow MD Anderson's advice and I wouldn't be concerned about a slight delay in BCG treatment. High grade is something that you don't want to mess around with. You want to be sure of the stage/grade and reduce the tumor load as much as possible before BCG is given. You have to be sure of the diagnosis to be sure of the treatment plan. It sounds like you're on the right track.
In my case, I had a TURBT by a local urologist and was diagnosised with TaG3. I had my slides and records sent to Sloan Kettering and I went down for a 2nd opinion. There Dr. Dalbagni did a cystoscopy in the office. Between that and their reading of my slides they were satisfied with the grading and margins so I didn't have a 2nd TURBT and started BCG about 4 weeks after the original surgery. If MSK had suggest it I would have has a 2nd TURBT and delayed BCG.
Getting a 2nd opinion is a wise move either way. They'll either catch something missed earlier or they'll give you peace of mind that you're doing all you can to treat your cancer. I hope all goes well for you.
47 yo, Ta G3
BCG induction starting 12/17/10 followed by BCG maintance.
The "gold" standard is re-doing the TURB. Almost all of us includimg me have had it done to be sure margins are done. MD Anderson is my backup should I ever need further opinions or help. I live in New braunfels and do have a well respected URO who does a lot of BC. I assume you are withing driving distance of MD? Good luck.
DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.