Is prostate removal possible after BCG?

Hi Lee

I think that it would be good to ask specific questions when you see the consultant. Hormone therapy for the prostate cancer is often started very quickly after diagnosis to deprive the body of testosterone which feeds the prostate cancer, though this didn’t happen for my father in law. 

If your husband isn’t on any kind of treatment for the prostate cancer (and he may well not be) I’d ask why not. Many men are on “Active Surveillance” for prostate cancer, but I’d ask the consultant how much his risk of a worsening of the bladder cancer might increase since he has another cancer in close proximity. 

I'm presuming the 2 cancers are distinct and separate types of cancer? Will there be biopsies of the prostate as well as the bladder when the effect of the BCG treatment is reviewed? My understanding is that yes, the prostate can be removed without the bladder being removed, because often that’s often the case for men with prostate cancer alone.

But you’d need to ask how much the effect of the BCG treatment (if any) would have on doing prostate surgery alone after BCG treatment. You should ask what effect BCG for the bladder may have on the prostate, since BCG is not a treatment for prostate cancer.

If the BCG is not successful in dealing with the bladder cancer(and recurrences of bladder cancer can happen even after BCG treatment) then you will need to ask about what will happen next. Hopefully since the consultant already recommended a cystectomy and your husband chose not to go ahead with it, the risks of that were well explained so that you are fully informed. Bladder cancer can become muscle invasive and change what might need to happen. 

Either removing the prostate alone, or removing the bladder and prostate at the same time are likely to have side effects for a man and it’s very important that you ask what these may be like for your husband. 

It’s always a patient’s choice to go ahead with any type of treatment or surgery and no-one has to undergo anything they don’t want to do, but you need to know all the risks involved with any particular course of action. 

Sarah xx

• Hi Sarah, thank you for taking the time for that in-depth reply, it really is much appreciated.  You are right that my husband knows he has taken quite a risk to decline the surgery (and I really wish he hadn't but it's not my body and so is not my decision) and it is very unlikely that the BCG will help with the prostate cancer (which has spread from the bladder as he was showing clear in the prostate last year before the bladder cancer came to light).  I guess we need to speak to the consultant and get some answers so we can be ready with a plan once the BCG has finished.  Lee xx

Hi Lee

I think in your position I’d ask too how non muscle invasive bladder spread to the prostate as that’s not common. The cancer has not gone to the bladder muscle lining if it’s non muscle invasive. so I’d ask them to explain the spread to the prostate, if that’s what’s happened. Have they confirmed by biopsy that it’s not 2 separate types of cancer?

I think the g3 in the diagnosis is important to consider too-these types of cells look the most abnormal when compared to normal cells and are high grade so more risky.

It’s absolutely your husband’s decision about the cystectomy of course, even if it goes against a recommendation made by his consultant, but many of us are living quite happily without a bladder and just very relieved to have the cancer removed. I had bladder removed and didn’t even have bladder cancer at all! 

Sarah xx

Thanks Sarah, I will definitely be asking those questions!  All actually don't know much about the prostate cancer and all we know is that the prostate biopsies showed carcinoma in situ.  To be honest I think we just assumed it had spread from the bladder as my husband had biopsies taken from the prostate late last year that were clear and this was before the bladder cancer was discovered. Lee xx

Hi Lee, I was diagnosed with prostate and bladder cancer in August 2023,   I was told the bladder cancer was more aggressive so was put on hormone therapy for the prostate cancer whilst I underwent BCG for the bladder, I had 15 BCG treatments up until January this year, In March I had my prostate removed (all good so far ) I restarted the maintenance doses of BCG in July and have 6 more doses to have in the next q2 months, hope this helps if you have any questions I'll try to answer them

                    Duncanxx

Hi Duncan, that is really useful information, thank you!  My husband hasn't been offered any treatment for the prostate cancer (all i know about the prostate cancer is that it is 'carcinoma in situ' whatever that means?) so that is definitely a question to be asked!  Am I right in thinking that BCG doesn't really do anything for prostate cancer?? 

Lee xx

Hi Lee, I the BCG is only for the bladder, hormone therapy basically stops you producing testosterone (which the prostate cancer feeds on ) hope that helps 

       Duncanxx

Hi Lee, just to let you know both of my cancers were primary cancers , my diagnosis is in my bio, hope you get the answers you need off you consultant

    Duncanxx

Hi Lee

Carcinoma in situ is abnormal cells, and not technically cancer, but can lead to cancer. It refers to cells which have not left their original location, so they haven’t spread to other tissue but it needs careful monitoring.

Sarah xx

Not every prostate cancer needs the prostate removed. I know people treated for it by ablation  (though I think that works for tumour 'within the capsule' - not sure what it means) and still OK 10 years afterwards. 

That may be worth asking about.

All the best,

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