Why is TUR required? What would be the potential advantages/disadvantages of BCG therapy without TUR? Can I read about this anywhere e.g. study articles?

Best regards,
Mr. I. L.

Dear Friend:

Response to BCG immunotherapy is limited by the volume of tumor.  In the mouse, only 1×10*3 cells can be reliably killed by BCG immunotherapy.  In men, the number is much higher.  Complete response rates for papillary tumors are about 60%.  Resection is important not only to reduce the tumor burden and improve response, but to establish the diagnosis, grade and stage of disease.

Thanks for asking,
Don Lamm, MD

My husband was diagnosed with cis two years ago. He received one treatment with bcg, then the cancer returned several months later. The bcg and interferon cancer still persists offering no more medical treatments only cystectomy. He is due to receive more biopsies next week to check kidneys and etc.

Do you have any suggestions?

Dear Friend,

CIS that persists after BCG therapy is dangerous, and at risk of progressing to muscle invasion.  Cystectomy in some patients can be life saving.  It is not, however, the only choice nor necessarily the best choice for all patients.  Your urologist is right to check the upper tracts and prostate, where CIS can hide and be very dangerous. BCG induction with 6 instillations is suboptimal, but failing to respond to BCG plus interferon is worrisome.  The recommendation for cystectomy is therefore appropriate.  Alternatives would include intravesical chemotherapy.  Mitomycin C and doxorubicin have response rates in the range of 50%, when given initially.  After BCG failure the response would be less.  There is an approved agent for BCG failures when cystectomy is not appropriate: Valstar.  Combination therapy with MMC followed by doxorubicin as well as new agents such as gemcitabine and docetaxel can also be used. After responding to chemotherapy, I would recommend getting back on 3-week maintenance BCG.

Thanks for asking,
Don Lamm, MD

My husband has been taking BCG treatments for six years. He had one reoccurance of non-invasive bladder cancer a year ago. The problem is he can hardly tolerate the treatments anymore and they have changed his antibiotics, frequent urination pills and he is in terrible pain, burning and hurting all of the time. He takes three in a row for three weeks and skips two weeks and has his scope.  The urologist has been told so many times but he has not done anything to help him. Is there an alternative to BCG and if so what is it?  Should he get a second opinion or does he need to see an oncologist instead of urologist?  We live in Baton Rouge, LA so if you have any recommendations for any physicians he could really use your help. He is discouraged so much he wants to stop the treatments. It is saving his life but he is miserable.

Thanks for your time.

Sincerely,
D. R., Baton Rouge, LA

Dear Friend,

There is no need to suffer with 3 week maintenance BCG.  The dose can be reduced to 1/100th, and Ofloxacin or Cipro can be taken 6 and 20 hours after instillation to reduce side effects.  Also, when side effects are strong, the interval between treatments can be increased.  You should do fine with 3 weekly instillations every 2 years now.

Good luck, and thanks for asking,
Don Lamm, MD