CIS Remains After 6-Wk BCG Induction

4 years 8 months ago #51794 by Mike M
CIS Remains After 6-Wk BCG Induction was created by Mike M
Hey Friends,
Just got the pathology results from my first BCG follow-up cystoscopy and biopsies last week. Two biopsies were benign but the third biopsy in the trigone area was diagnosed at "Focal carcinoma in-situ in a background of urothelial dysplasia. Detrusor muscle present. Negative for invasive carcinoma."

So my question is since the CIS has remained in one spot after my initial 6-wk BCG induction course (finished in Apr), should I go for another 6-wk BCG induction or is it time for the RC? I thought per Dr Lamm, you needed to allow BCG to work for 6 months before declaring failure. Since I finished in Apr, shouldn't I wait until Oct to see if I completely respond to the BCG or am I playing with fire? Anyone been in a similar scenario where CIS remained and BCG was continued?

Thanks!

12/15 - Diagnosed Ta HG, 1.5cm Pap, Focal CIS
3/16 - Began BCG following NCCN and SWOG guidelines
2/19 - Ta HG recurrence and CIS/Ta HG in right kidney/ureter
2/19 - Nephroureterectomy to remove right kidney/ureter
9/19 - BCGx33 completed
2/20 - Invasive HG urothelial pT2 in prostate stroma

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4 years 8 months ago #51795 by sara.anne
Replied by sara.anne on topic CIS Remains After 6-Wk BCG Induction
Mike, this is one to have a serious discussion with your urologist, no holds barred. You need to know all the pros and cons of any approach. You also might want to seek a second opinion at a place that does a LOT of bladder cancer treatment, if you aren't already at one.

Sometimes BCG is continued for a while, often with interferon added. However, CIS is not something to fool around with.

So sorry to hear this.

Wishing you all the best

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
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4 years 8 months ago #51796 by Jack R
Replied by Jack R on topic CIS Remains After 6-Wk BCG Induction
Mike,
I am a bit ahead of you on this path. I offer two articles as a starting point toward (MY) making an informed but questionable decision.

I had a hard facts discussion with the doc, including the nuances of the biopsy results (first clear, then new or remaining CIS) about how long to try to save the bladder before going the RC route. My concerns include the high percent of RC's that prove invasive when examined after removal. My desire is treat as long as the (presumed) chance of undetected invasion is low.

Based on much journal research and, most importantly, the findings in MY situation, I chose to go for a second course of BCG with follow ups. I am two months away from the next scope, CT and TURBT, which will either make the next decision easy or restart the risk assessment of how long to treat.

Tough decision with a lack of authoritative research applicable at the individual level.

Best
Jack
Can Urol Assoc J. 2009 Dec; 3(6 Suppl 4): S199–S205.
PMCID: PMC2792453
The management of BCG failure in non-muscle-invasive bladder cancer: an update

www.ncbi.nlm.nih.gov/pmc/articles/PMC2792453/

Adv Urol. 2015; 2015: 656918.
Published online 2015 Oct 13. doi: 10.1155/2015/656918
PMCID: PMC4621325
The Role of Interferon in the Management of BCG Refractory Nonmuscle Invasive Bladder Cancer
www.ncbi.nlm.nih.gov/pmc/articles/PMC4621325/

6/2015 HG Papillary & CIS
3 Years and 30 BCG/BCG+Inf
Tis CIS comes back.
BC clear as of 5/17 !
RCC found in my one & only kidney 10/17
Begin Chemo; Cisplatin and Gemzar
8/18 begin Chemo# 3
Begin year 4 with cis
2/19 Chemo #4
9/19 NED again :)
1/2020 CIS is back
Tried Keytruda, stopped by side effects
Workin on a new plan for 2021
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4 years 8 months ago #51798 by Mike M
Replied by Mike M on topic CIS Remains After 6-Wk BCG Induction
Thanks Sara Anne.
As a military retiree, I'm being treated at Brooks Army Medical Ctr in San Antonio under Tricare (Humana). Scheduled to meet Urology Dept resident next week to discuss path rpt and way ahead. My staff urologist has been recommending RC since day one. Will discuss possibility of one more 6-wk BCG induction course with interferon as you mentioned. Will also discuss getting a 2nd opinion from the NCI designated CTRC here in San Antonio. Would have already been seeking treatment at the CTRC, but Tricare requires you seek care at military facilities first (if capable of providing the medical service needed). Was hoping I could kick the can down the road at least until next year when I turn 65 and go on Medicare. Then I could seek care at the CTRC with no problem.

12/15 - Diagnosed Ta HG, 1.5cm Pap, Focal CIS
3/16 - Began BCG following NCCN and SWOG guidelines
2/19 - Ta HG recurrence and CIS/Ta HG in right kidney/ureter
2/19 - Nephroureterectomy to remove right kidney/ureter
9/19 - BCGx33 completed
2/20 - Invasive HG urothelial pT2 in prostate stroma

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4 years 8 months ago #51799 by Alan
Replied by Alan on topic CIS Remains After 6-Wk BCG Induction
Mike

I am not up to speed with Tricare rules. However, if you are allowed to get to MD Anderson in Houston I'd reach for that hospital.

Thanks for your service!

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.
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4 years 8 months ago #51800 by Mike M
Replied by Mike M on topic CIS Remains After 6-Wk BCG Induction
Thanks Jack,

Yes, our paths seem very much alike as do our treatment approaches. Thanks for the two articles, and you're absolutely right...a tough decision...choose pre-emptive RC now or continue to "dance around the fire". I'm hoping one more 6-wk BCG course (with perhaps interferon added) will produce NED, before the "cat gets out of the bag."

Best wishes,
Mike

12/15 - Diagnosed Ta HG, 1.5cm Pap, Focal CIS
3/16 - Began BCG following NCCN and SWOG guidelines
2/19 - Ta HG recurrence and CIS/Ta HG in right kidney/ureter
2/19 - Nephroureterectomy to remove right kidney/ureter
9/19 - BCGx33 completed
2/20 - Invasive HG urothelial pT2 in prostate stroma

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