Thank you for all of that good info. I am hoping for the outcome as you have outlined. I should not have been surprised at a recurrence but I must admit, I was! The recurrence rate for this type of BC is so high - tough to get around it. I have a friend who has gone 9 years - she will never stop seeing her uro she says. I am with her on that. I will post the results of my cysto of 9/11 -- thanks again.
How it is determined to have BCG treatment depends on risk stratification which depends upon the grade but also other factors. For NMIBC, the classification is low risk, intermediate risk, high risk. Any high-grade tumor is classified as high risk. Even it is low grade, it is classified as the intermediate-risk if the tumor is greater than 3 cm, it has multiple tumors, or if the tumor is recurrence.
TaLG - single, < 3 cm, the first time is considered low risk
TaLG - multiple, and/or > 3cm, and or recurrence is considered as intermediate risk.
TaHG, T1HG, CIS - are considered high risk
Above risk stratification is the result of a large study (2,600 patients) done by EORTC (European Organisation for Research and Treatment of Cancer) which was published in 2006. It resulted in a simple risk calculation table.
I have listed a link to the risk calculation.
In a low-risk patient, a clinician should not administer induction intravesical therapy. (Moderate Recommendation; Evidence Strength: Grade C)
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 a high-risk patient with newly diagnosed CIS, high-grade T1, or high-risk Ta urothelial carcinoma, a clinician should administer a six-week induction course of BCG. (Strong Recommendation; Evidence Strength: Grade
Please note that these are guidelines and clinical doctors may choose a slightly different treatment based upon his or her clinical experience and other evidence.
AUA guideline explains that long-term follow up of low-grade Ta lesions demonstrates a recurrence rate of approximately 55%, but with a much lower percentage (6%) experiencing stage progression.
So, if the original diagnosis was that it was a single tumor, no CIS, LG, < 3cm, then even the recurrence puts you to the intermediate-risk category, because it happens once 5 years later, I incline to think that your urologist will not put you on BCG and put you on surveillance by regular cystoscopy. But it is possible to treat you with one time intravesical chemotherapy to reduce the possibility of future recurrence.
Please note that the current grading system (LG,HG) came out in 2004 by WHO. Prior to (LG,HG) grading system, (G1,G2,G3) rading system was used and even today some urologits contitue to use old grading system, ie. my urologist. G2 is considered in between LG and HG.
AUA (American Urological Association) site on the guidelines for NMIBC
That helps to clarify this nasty disease. So if this lesion turns out to be low grade, since it is first I have had since turmor of 5 years ago, I will probably not get bcg - but if I continue to get lesions or tumors, then it will be used?
BCG is highly effective for high grade superficial bladder cancer. It is not as effective for early diagnosed low grade, and so it is not used. Better to save it for when you might really need it. BCG IS used for recurrent low grade tumors.
There are multiple options for when BCG cannot be used due to toxicity or unavailability. These include mitomycin and other immune-stimulating agents.
There are lots of things available, with BCG being the "gold standard."
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Question regarding bcg. Is it only used for high grade bc? Low grade does not receive treatment after surgery (except mitomycin immediately)? If you are one of those people who cannot tolerate bcg for one reason or another, or cannot tolerate chemo of some sort, are the only options repeated surveillance and turbts?