G3PT1 - BCG vs Radical Cystoscopy the choice and rationale

My husband had radical prostacystocopy as his cancer was aggressive , So bladder removal was tge best option for him 

Cheers Camcm,

many thanks for the reply. Mine too is aggressive, so it “may” be the best option for me too, if there is a choice. If for example recurrence is very high, or progression also high. 

cheers

I was G3pT1 N0 Mo and was given the choice of BCG or RC at the OP meeting following TURBT 1. Initially plumbed for BCG to retain bladder for a bit longer but had time to research and think before 2nd TURBT, At OP appointment post TURBT No 2 I advised that I had  decided to have the RC. Referred to surgeon who advised best to start with BCG in my case with backup of clinical trials or RC if ineffective .or not tolerated. Completed 9 BCG so far and all looking good. Just waiting for next flexi.

I've posted several times in the past about this. I was 'only' TaG3 but given the option of BCG or RC. Before my second TURBT (to confirm staging) I was hoping BCG would still be an option, but gradually I came round to choosing surgery instead. There were various factors - I weighed up the time taken out of my life for BCG treatment compared with surgery (about the same in total no days); the chances of cure (might go through BCG & still need surgery, possibly later in life when not so able to cope); the risk of muscle invasive recurrence (needing chemo); getting on with my life with peace of mind (job I enjoyed, elderly mother might need more care, leisure pursuits etc). Helped perhaps that I did not fear hospitals /surgery, had confidence in my surgeon.

It is a very personal decision, we each have different priorities, life circumstances, attitudes to risk etc that influence us. My CNS recently said that we usually manage to make the decision that is right for us.

Then had the decision stoma or neo - another difficult one! Anyway, I had my op 12 years ago & have never regretted my choice. 

Thanks Teaswill - I have more or less decided to have surgery if it’s a choice for the reasons that you put forward, which are very sensible. If this happens I will go for the bag, less plumbing. I discussed it with my consultant as a theoretical possibility, I sense he is the same camp, but likes the patient to make the choice.

I am re-reading you reply, for which I thank you. It is often in my mind to be honest. I could add that a RC after BCG where MIBC is found has a worse prognosis that doing it right away. A lot worse. Cheers Leo

My father in law had MIBC and chemo wasn’t an option due to heart issues. He went straight to bladder removal last year and was happy to do so, because it was his only choice apart from do nothing which wasn’t an option in his mind. I had my bladder removed more than 4 years ago, but didn’t have bladder cancer, so a different situation for me. 

Sarah xx

I've posted in another similar thread. This very useful:

actionbladdercanceruk.org/.../ABC-BLADDER-DECISION-AID-A5.pdf

My consultant told me that 50% people having BCG end up having surgery, with or without chemo (or chemo plus radiotherapy). 

Thanks Teasswill, yes-it’s a very useful guide. 

Sarah xx

Thanks for this - I was re-reading today. It’s a dilemma for sure. I have started to see some threads on the forum which are in effect quite dismissive of BCG treatment, which are not very helpful to say the least for those on that treatment. They tend to treat having a RC in a rather casual way, which I think is erroneous, it’s major surgery. Having said that your posts on this topic have been more nuanced and helpful. So thanks. Leo