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Ask Dr. Lamm

Bladder Cancer

April 23rd, 2010

Dr. Lamm,

I must tell you that you and your expertise has helped me so much… thank you.

Question: I am 53yo male, Caucasian dx with bladder cancer TCC Ta Jan 2010,  status post TURBT 4 tumors removed largest 3cm and 6 BCG tx. 2nd scope today, no tumors however multiple spots on top of bladder - Urologist advises possible reaction to BCG - last tx 3 weeks ago or CIS? could TCC Ta have converted in less than 4 months? opinion? scheduled for biopsy - waiting is sometimes the hardest part. Thank you for your precious time!!

A. M.

Dear Allen,

Yes, it is very common, indeed expected that there will be reaction in the bladder from BCG.  This is, generally speaking, a good thing.  Cytology will likely be negative, in which case it is not required to do a biopsy.  Be sure, if you can, to get 3 week maintenance BCG.  Recent data now show it reduces death from bladder cancer by more than 60%- that less than half as many deaths as with other treatments. Best regards,
Don Lamm, MD

BCG and Alzheimer’s Disease

April 23rd, 2010

My father is receiving BCG therapy…he is now in his fourth week.  My question is this…my mother says he seems to be experiencing Alzheimer-like symptoms such as not remembering things, making incorrect statements about his family…just basically seeming disoriented most of the time.  He is only 67-years-old and these symptoms started shortly after staring the therapy.  If there is anything you could tell me I would greatly appreciate it.  He is kind of stubborn and denies having any of these symptoms and refuses to consult a physician.

Thank you very much!

Dear Friend,

I am sorry to hear of your father’s bladder cancer and symptoms of Alzheimer’s disease.  BCG has been used to test immune function in patients with Alzheimer’s, and evidence shows that Alzheimer’s is associated with an impaired immune response when compared with patients of similar age.  I have found no reports of Alzheimer’s being promoted by BCG.  The diagnosis and treatment of cancer is a major stress, and it could be that this has aggravated symptoms of memory loss.  Hopefully this will be temporary, but he should see a physician for this.

Thanks for asking,
Don Lamm, MD

My doctory says I don’t need maintenance BCG for T1G3 TCC. What should I do?

April 4th, 2010

I have transitional cell carcinoma of the bladder. It is T1G3 grade. I had undergone 2 tur-bt, and 6 weekly BCG treatments. This was completed in October 2009. Now the sonography shows no tumor, and my doctor told me not to undergo further BCG. Please advise should i continue BCG, how many times, and at what amount?

Dear Friend,

Unfortunately there is a recent publication by a renowned, but in my opinion not well informed urologist that questions the value of maintenance BCG.  This, in my opinion, is potentially a deadly error.  My SWOG study showed that compared with  6 week induction BCG, 3 week maintenance significnantly reduced recurrence and disease progression.  Survival was also increased but this advantage did not reach the level of statistical significance (overal survival increasing at ten year “only” from 52 to 58%).  It is true that several maintenance studies using regimens other than 3 week maintenance have been unsuccessful, but when studies are combined in meta-analysis maintenance is clearly superior.  My work has been recently confirmed by the EORTC.  In a study of 957 patients followed for 9.2 years 3 week maintenance BCG significantly reduced recurrence, metastasis, and overall as well as cancer specific death.  I a study in press from Dr. Akaza in Japan, 3 week maintenance was again confirmed to reduce recurrence and progression.  That study treated for only 18 rather than 36 months, and recurrence began to increase one year after completion of treatment.
So, if your doctor wishes to reduce your risk of recurrence, progression, metastasis and death he would be well advised to use the 3 week maintenance schedule.

Thanks for asking,
Don Lamm, MD