Mistersac,
As I understand it, you had one biopsy after the initial six dose BCG induction course, and that six sites were sampled. Correct ? A biopsy of multiple sites, including random sites, taken at one time, often checking for CIS, is generally described as one biopsy.
There is one misunderstanding of Dr. Lamm's findings: In the specific case of CIS, the following articles support a "additional round" at three months and evaluation of CIS at 6 months.
The following paragraph from:
www.nature.com/nrurol/journal/v12/n4/full/nrurol.2015.58.html
Describes Lamm's findings, beginning in the first paragraph following the graphs (about page 9, with the article at 9 point type)
Regarding CIS"... 6 months is a preferred time to evaluate response.."
"The potential benefit of 3-week BCG maintenance deserves emphasis. Specifically, the schedule is initiated with weekly intravesical and percutaneous BCG treatment for 6 weeks, followed by further weekly combination treatment for 3 weeks after routine cystoscopy at 3, 6, 12, 18, 24, 30 and 36 months.12 Only 14% of patients completed treatment in the original study, but compliance in modern studies is high. In the population with CIS, complete response at 6 months in patients randomized to receive the initial 6-week BCG treatment only (induction arm) was 69% in comparison with 84% (P <0.01) in patients randomized to receive the additional 3-week maintenance treatment (maintenance arm).12 In the maintenance arm, complete response increased from 55% at 3 months to 84% at 6 months (64% complete response in patients with treatment failure at 3 months). Even without additional BCG, 26% of patients with residual disease at 3 months in the induction arm went on to have complete response by 6 months, illustrating that 6 months is a preferred time to evaluate response."
Also see:
Management of carcinoma in situ of the bladder, Tang and Chang, is a review of the work of Lamm and others, beginning at the header, "Intravesical BCG Therapy", which expands on the first citation about CIS and BCG.
"The role and efficacy of BCG induction plus maintenance therapy for treatment of CIS was determined by the Southwest Oncology Group (SWOG) 8507 trial [Lamm et al. 2000]"
www.ncbi.nlm.nih.gov/pmc/articles/PMC4647140/
The articles offered here and prior reflect my current understanding of first line of attack against NMIBC CIS using BCG.
I hope this helps you and your doctor reach a decision that is comfortable to you.
Best
Jack