21 year-old non-smoker with BC

2 years 9 months ago #60335 by joea73
Replied by joea73 on topic 21 year-old non-smoker with BC
Something your urologist did not do right unless the urologist had a valid reason not to do it, is that the urologist did not give intravesical chemotherapy right after the first TURBT. Below is American Urology Association guidelines for managing non-muscle-invasive bladder cancer on the subject.

AUA Guideline Statement 15
The rationale for postoperative instillation of intravesical chemotherapy includes both destruction of residual microscopic tumor at the site of TURBT and of tumor cells dispersed within the bladder. 129-131 A single postoperative instillation of intravesical chemotherapy after TURBT has been demonstrated in multiple studies to decrease tumor recurrence without effects on progression or survival. Three separate meta-analyses have reported that a single postoperative instillation of chemotherapy significantly decreases tumor recurrence between 10-15% compared to TURBT alone.

So, this makes it ambiguous to know the true cause of future recurrences. Anyway, we cannot turn the clock.

2020-08 TaLG, 2 cm, single
2021-06 Benign, 2 mm, 2 sites
2021-12 ??, 1 mm, 5 sites
2021-03 if recurrence, BCG - urologist recommendation

1. TaLG rarely changes to high grade.
2. Because BCa is so rare in younger people, they have not been many studies done for the treatment and prognosis.
3. AUA Guideline Statement 16 - In a low-risk patient, a clinician should not administer induction intravesical therapy. (Moderate Recommendation; Evidence Strength: Grade C)
4. AUA Guideline Statement 17 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 B)
5. There are several studies done to compare the efficacy and side effects between Intravesical chemotherapy and BCG. Early studies are done on mitomycin and more recent studies are done on Gemcitabine.

5.1 In terms of toxicity, a study shows Intravesical gemcitabine was associated with a trend toward better DFS (disease-free (recurrence or progression) survival) with significantly lower toxicity when compared with BCG.

5.2 In terms of efficacy, the report (2003) which compared several studies said the efficacy is about the same but BCG is better for progression-free. The study with gemcitabine shows that the DFS rate at 6 and 12 months was consistently better with gemcitabine compared to BCG (100 versus 83% and 85 versus 64%, respectively). Look at the graph in the paper. The link is given below.

In conclusion, I believe it depends upon the urologist if the urologist will recommend intravesical chemotherapy or BCG in this case. The data incline to lead to the suggestion that 6 weeks induction of Intravesical chemotherapy with Gemcitabine is a more appropriate treatment than BCG to prevent recurrence for young patients with low-grade BCa. Anyway, at least the urologist should evaluate which is a more appropriate treatment for this case.


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2 years 9 months ago #60333 by sara.anne
Replied by sara.anne on topic 21 year-old non-smoker with BC
First, as you know, it is very unusual for someone at your age to present with bladder cancer. That fact alone probably has your urologist on his toes.

Second, BCG is used when the initial tumor is high grade. It is also the treatment of choice when there are persistent recurrences. It is the recurrence issue, rather than the number of tumors, that would indicate the need for BCG. Your urologist is doing exactly what should be done in your case. IF it returns BCG may prevent it doing so again.

Please let us know how your exam goes!!

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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2 years 9 months ago #60330 by kero816
21 year-old non-smoker with BC was created by kero816
21 yr-old non-smoker here...I have been reading this forum since my initial diagnosis last year. It's very supportive and I really appreciate it :) After the recent recurrences I would like to know your views. I have been having regular 3-month checks since initial diagnosis

Initial diagnosis: August 2019 - single tumour of 2cm low grade papillary, non-invasive, TURBT done and sent home (no injection or anything given after TURBT)

1st recurrence: June 2020 - TWO tiny tumours each 2mm, pathology found out there is no malignancy, "submucosal soft tissue focally lined by attenuated benign urothelium", no treatment after TURBT

2nd recurrence: December 2020 - FIVE tiny tumours each 1mm, waiting for pathology

Urologist said if I have a recurrence on my next check-up (3 months later) I will need BCG. Thoughts? It seems that BCG is only useful for high-grade

Additionally I would like to know does it mean I'm in trouble with each recurrence happening more frequent?

Also, is FIVE tumours a serious issue that warrants BCG?

Any input is hugely appreciated :)

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