Radical cystectomy Vs BCG treatment choice with aggressive non-muscle invasive bladder cancer

I was also looking at these papers, both retrospective long term follow ups - caveat is obviously that these look at individuals diagnosed decades ago so treatment recommendations have changed and therefore things might be different now. My assumption is that expert specialists will have more accurate info but there really is a lack of good reliable data out there!

Shahin et al 2003

pubmed.ncbi.nlm.nih.gov/.../

• Conclusions: Our results suggest that intravesical BCG therapy after transurethral bladder resection for stage T1 grade 3 bladder cancer may delay the time to recurrence and cystectomy but it does not substantially alter the final outcome. Our findings reflect the rule of 30% for stage T1 grade 3 cancer, namely approximately 30% of patients never have recurrence, 30% ultimately die of metastatic disease and 30% require deferred cystectomy.

and Thiel et al https://pubmed.ncbi.nlm.nih.gov/29905887/

Similar findings, BCG does delay and reduce recurrence but not for high grade (T1G3) cases.

I’ll follow up if I find further or better data.

Good luck everyone, tough choices, in the end each of us need to decide what risk we’re willing to take and regardless, there is unfortunately no clear way to predict outcomes for each individual. 

xx

Mikeyab, Those publications use quite small sample sizes which limit their utility. This is quite good https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer Leo

Hi. My apologies for delay in responding. T1G3 is a high risk pathology regardless of the size. The chances of recurrence/ progression are more if there is other finding, e.g. CIS, variant pathology etc. The recent NICE guidelines do mention size and number of tumours in the prognosis section, so I assume there is a link between these variables and prognosis. I wish you all the best with your decision. 

Super helpful thanks Leo1!

Hi Leo1, I followed your link. Thank you for that. It says that high risk is at a 14% risk of progression at 10 years without BCG. I assume it's lower with BCG. I wonder how much. 

Hello everyone,

I have a question if ok for anyone who has had a RC. My husband is 14 months post op (RC with Iliad conduit) doing well but we ve noticed a eGFR value was 63 and creatinine value of 114 on his recent blood test. This is worse that a few months ago and I m concerned about a decline in kidney function. I read this can happen after RC.  I d be very grateful for any information. Thank you. 

Hi,I had a cystectomy in 2019 and was told that renal function can decline afterwards.I had normal kidney function blood tests until last year when there was some drop in GFR and creatinine.I also had hydronephrosis in both kidneys in 2022 but by this years scan the swelling had gone.My urologist said that can happen post op.I hope they will monitor your husband’s kidney function closely.Best wishes Jane 

Thank you Jane, may I ask if you think GFR value of 63 and creatinine of 114 is significant?

You have to go by your consultant's opinion. My GFR has dropped & I have slight hydronephrosis. GFR is below normal & google would say that's kidney disease, but my hosp seems quite happy about it. If they have nay concerns they will do more tests. 

I had bladder removal in 2020 and have never had a kidney issue until now, where recent blood tests have shown some potential issues. However, I need a repeat blood test in the next week or so to check again. My creatinine is higher than normal as is my eGFR. I’m just going to wait to chat through with my doctor. 

Sarah xx