What to do when lower grade recurrence happens?

1 month 1 day ago #60757 by Senter
2 and a half years ago my father was diagnosed with T1G3 + CIS in his bladder.

He had TURBT and 6 doses of BCG and then went on maintenance.

6 months ago they found a red lesion, did TURBT, but it was benign. (not sure if this is relevant)

Now in his last cystoscopy, his doctor saw a papillary tumor in a completely different spot.

The papillary tumor is not round. It's more like a line / streak, its dimensions seem to be approx 1cm x 1mm (and 1mm height), which to me seems like a weird shape.

My father also had a cytology which was completely negative (not even suspicious or atypical)

He is scheduled for TURBT / Biopsy in 2 days.

Now my questions:

1. Considering the tumor seems small, and cytology was negative, isn't this unlikely to be High Grade?

2. If this is Low Grade, what is the typical treatment response after TURBT?

The doctor, who also thinks this is likely low grade, talked about either restarting BCG regime, or changing the drug to MMC. And I'm a little perplexed.

In my mind BCG has successfully treated my father's original T1G3, and since that hasn't recurred I don't think BCG has failed, so changing drugs to something that is potentially less effective for the high grade tumor seems like a bad idea. It also doesn't feel like a big enough failure to me to warrant completely restarting the BCG treatment (I wouldn't mind this option, but I don't think my father may have trouble handling the side effects of another induction + more aggressive maintenance)

Does anyone have any information of what is usually done in similar situations? I've looked around but I haven't stumbled upon a similar situation as my father's.

We are going to consult other doctors after we have the biopsy results and we know what we're dealing with, but I just want to inform and prepare myself beforehand.

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1 month 19 hours ago - 1 month 15 hours ago #60759 by Alan
From my perspective your URO is asking and trying all the correct buttons. Papillary tumors are different than CIS which are always high grade. The usual protocol on low grade is watch and wait unless there is a recurrence. Thus, either way, BCG is the most prescribed agent and I believe statistically a slight preference over the chemo cocktails. Everyone still responds differently. For peace of mind as you have opined, a second opinion is probably a good idea. If for nothing else, "fresh eyes". That way you will have 2 minds working toward what agent may be best. Quite frankly, both should be good.

Adding that caregivers are very important! Give yourself a big pat on the back. Also, please post what happens as many will learn and gain knowledge with every post.

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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