Clinical Scenario: Initial High-Grade Ta Tumor

45-Year-old healthy man with his first large, high-grade Ta cancer
  • José L. Domínguez-EscrigEmail author
  • Eduardo Solsona Narbón


With a worldwide incidence rate of 9 per 100,000 for men and 2 per 100,000 for women, bladder cancer is the most common malignancy of the urinary tract, representing the 7th and 17th most frequent malignancy in men and women.

At presentation, 75–85 % of cases are confined to the mucosa or sub-mucosa, being grouped as non-muscle-invasive bladder cancer (NMIBC). However, this is a very lose heading as evidenced at a molecular level and by the very different clinical behavior among these tumors. Regarding pTa G3 disease, the evidence for clinical management, often extrapolated from pT1 high-grade disease, remains limited.

In this clinical scenario, we present a case of a 45-year-old male with a high-grade (G3) pTa urothelial carcinoma of the urinary bladder. We review the logic diagnostic approach, the importance of an accurate staging, as well as, the currently available diagnostic tools. In particular, we review the role of Re-TUR, novel endoscopic aids, and urine tumor markers. Finally, we focus on the role of BCG therapy for these patients.


Urothelial carcinoma pTa G3 NMIBC RE-TUR Urine markers and BCG 



5-Aminolevulinic acid


American Urology Association


Bacillus Calmette-Guerin


Carcinoma in situ


Club Urológico Español de Tratamiento Oncológico


European Association of Urology


Hexaminolevulinic acid


International Bladder Cancer Group


Mytomicin C


Narrow band imaging


National Institute of Clinical Excellence


Photodynamic diagnosis


Progression-free survival


Recurrence-free survival


Re trans-urethral resection


Trans-urethral resection


White light cystoscopy


  1. 1.
    Ferlay, Shin H, Bray F, Forman D, Mathers C, Parkin D. Globocan 2008: cancer incidence and mortality worldwide 2010. International Agency for Research on Cancer: Lyon, France. IARC CancerBase No. 10.Google Scholar
  2. 2.
    Sylvester RJ, Brausi MA, Kirkels WJ, Hoeltl W, Da Calais SF, Powell PH, Prescott S, Kirkali Z, van de Beek C, Gorlia T, de Reijke TM. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol. 2010;57(5):766–73.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Lebret T, Bohin D, Kassardjian Z, Herve JM, Molinie V, Barre P, Lugagne PM, Botto H. Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations. J Urol. 2000;163(1):63–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Sternberg IA, Keren Paz GE, Chen LY, Herr HW, Donat SM, Bochner BH, Dalbagni G. Upper tract imaging surveillance is not effective in diagnosing upper tract recurrence in patients followed for nonmuscle invasive bladder cancer. J Urol. 2013;190(4):1187–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Goessl C, Knispel HH, Miller K, Klan R. Is routine excretory urography necessary at first diagnosis of bladder cancer? J Urol. 1997;157(2):480–1.PubMedCrossRefGoogle Scholar
  6. 6.
    Solsona E, Iborra I, Ricos JV, Dumont R, Casanova JL, Calabuig C. Upper urinary tract involvement in patients with bladder carcinoma in situ (Tis): its impact on management. Urology. 1997;49(3):347–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Holmang S, Hedelin H, Anderstrom C, Holmberg E, Johansson SL. Long-term followup of a bladder carcinoma cohort: routine followup urography is not necessary. J Urol. 1998;160(1):45–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Palou J, Rodriguez-Rubio F, Huguet J, Segarra J, Ribal MJ, Alcaraz A, Villavicencio H. Multivariate analysis of clinical parameters of synchronous primary superficial bladder cancer and upper urinary tract tumor. J Urol. 2005;174(3):859–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Huguet-Perez J, Vicente-Rodriguez J. Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol. 2000;164(4):1183–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Solsona E, Iborra I, Ricos JV, Monros JL, Dumont R, Almenar S. Extravesical involvement in patients with bladder carcinoma in situ: biological and therapy implications. J Urol. 1996;155(3):895–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Sylvester RJ, van der MEIJDEN AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49(3):466–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Pineiro L, Ojea A, Portillo J, Montesinos M, Gonzalez M, Pertusa C, Rodriguez-Molina J, Camacho JE, Rabadan M, Astobieta A, Isorna S, Muntanola P, Gimeno A, Blas M, Martinez-Pineiro JA. The EORTC tables overestimate the risk of recurrence and progression in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guerin: external validation of the EORTC risk tables. Eur Urol. 2011;60(3):423–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Pineiro L, Gonzalez M, Portillo J, Ojea A, Pertusa C, Rodriguez-Molina J, Camacho JE, Rabadan M, Astobieta A, Montesinos M, Isorna S, Muntanola P, Gimeno A, Blas M, Martinez-Pineiro JA. Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol. 2009;182(5):2195–203.PubMedCrossRefGoogle Scholar
  14. 14.
    Mariappan P, Smith G, Lamb AD, Grigor KM, Tolley DA. Pattern of recurrence changes in noninvasive bladder tumors observed during 2 decades. J Urol. 2007;177(3):867–75.PubMedCrossRefGoogle Scholar
  15. 15.
    Brausi M, Collette L, Kurth K, van der MEIJDEN AP, Oosterlinck W, Witjes JA, Newling D, Bouffioux C, Sylvester RJ. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol. 2002;41(5):523–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Herr HW, Donat SM. Quality control in transurethral resection of bladder tumours. BJU Int. 2008;102(9 Pt B):1242–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Mariappan P, Zachou A, Grigor KM. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol. 2010;57(5):843–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Herr HW. The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol. 1999;162(1):74–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Dutta SC, Smith Jr JA, Shappell SB, Coffey CS, Chang SS, Cookson MS. Clinical under staging of high risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol. 2001;166(2):490–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Vasdev N, McKie C, Dominguez-Escrig J, El-Sherif A, Johnson M, Durkan G, Rix D, Thorpe A. The role of early re-resection in pTaG3 transitional cell carcinoma of the urinary bladder. BJMSU. 2013;4(4):158–65. Elsevier.Google Scholar

Ref Type: Generic

  1. 21.
    Schips L, Augustin H, Zigeuner RE, Galle G, Habermann H, Trummer H, Pummer K, Hubmer G. Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer? Urology. 2002;59(2):220–3.Google Scholar
  2. 22.
    Ali MH, Ismail IY, Eltobgy A, Gobeish A. Evaluation of second-look transurethral resection in restaging of patients with nonmuscle-invasive bladder cancer. J Endourol. 2010;24(12):2047–50.PubMedCrossRefGoogle Scholar
  3. 23.
    Han KS, Joung JY, Cho KS, Seo HK, Chung J, Park WS, Lee KH. Results of repeated transurethral resection for a second opinion in patients referred for nonmuscle invasive bladder cancer: the referral cancer center experience and review of the literature. J Endourol. 2008;22(12):2699–704.PubMedCrossRefGoogle Scholar
  4. 24.
    Divrik RT, Sahin AF, Yildirim U, Altok M, Zorlu F. Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and disease-specific survival: a prospective randomised clinical trial. Eur Urol. 2010;58(2):185–90.PubMedCrossRefGoogle Scholar
  5. 25.
    Herr HW, Donat SM, Dalbagni G. Can restaging transurethral resection of T1 bladder cancer select patients for immediate cystectomy? J Urol. 2007;177(1):75–9.PubMedCrossRefGoogle Scholar
  6. 26.
    Liu JJ, Droller MJ, Liao JC. New optical imaging technologies for bladder cancer: considerations and perspectives. J Urol. 2012;188(2):361–8.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 27.
    Geavlete B, Jecu M, Multescu R, Georgescu D, Geavlete P. HAL blue-light cystoscopy in high-risk nonmuscle-invasive bladder cancer–re-TURBT recurrence rates in a prospective, randomized study. Urology. 2010;76(3):664–9.PubMedCrossRefGoogle Scholar
  8. 28.
    Schmidbauer J, Witjes F, Schmeller N, Donat R, Susani M, Marberger M. Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy. J Urol. 2004;171(1):135–8.PubMedCrossRefGoogle Scholar
  9. 29.
    Mowatt G, N'Dow J, Vale L, Nabi G, Boachie C, Cook JA, Fraser C, Griffiths TR. Photodynamic diagnosis of bladder cancer compared with white light cystoscopy: Systematic review and meta-analysis. Int J Technol Assess Health Care. 2011;27(1):3–10.PubMedCrossRefGoogle Scholar
  10. 30.
    Draga RO, Grimbergen MC, Kok ET, Jonges TN, van Swol CF, Bosch JL. Photodynamic diagnosis (5-aminolevulinic acid) of transitional cell carcinoma after bacillus Calmette-Guerin immunotherapy and mitomycin C intravesical therapy. Eur Urol. 2010;57(4):655–60.PubMedCrossRefGoogle Scholar
  11. 31.
    Ray ER, Chatterton K, Khan MS, Chandra A, Thomas K, Dasgupta P, O’Brien TS. Hexylaminolaevulinate fluorescence cystoscopy in patients previously treated with intravesical bacille Calmette-Guerin. BJU Int. 2010;105(6):789–94.PubMedCrossRefGoogle Scholar
  12. 32.
    Schumacher MC, Holmang S, Davidsson T, Friedrich B, Pedersen J, Wiklund NP. Transurethral resection of non-muscle-invasive bladder transitional cell cancers with or without 5-aminolevulinic Acid under visible and fluorescent light: results of a prospective, randomised, multicentre study. Eur Urol. 2010;57(2):293–9.PubMedCrossRefGoogle Scholar
  13. 33.
    Stenzl A, Penkoff H, Dajc-Sommerer E, Zumbraegel A, Hoeltl L, Scholz M, Riedl C, Bugelnig J, Hobisch A, Burger M, Mikuz G, Pichlmeier U. Detection and clinical outcome of urinary bladder cancer with 5-aminolevulinic acid-induced fluorescence cystoscopy: a multicenter randomized, double-blind, placebo-controlled trial. Cancer. 2011;117(5):938–47.PubMedCrossRefGoogle Scholar
  14. 34.
    Hermann GG, Mogensen K, Carlsson S, Marcussen N, Duun S. Fluorescence-guided transurethral resection of bladder tumours reduces bladder tumour recurrence due to less residual tumour tissue in Ta/T1 patients: a randomized two-centre study. BJU Int. 2011;108(8 Pt 2):E297–303.PubMedCrossRefGoogle Scholar
  15. 35.
    Stenzl A, Burger M, Fradet Y, Mynderse LA, Soloway MS, Witjes JA, Kriegmair M, Karl A, Shen Y, Grossman HB. Hexaminolevulinate guided fluorescence cystoscopy reduces recurrence in patients with nonmuscle invasive bladder cancer. J Urol. 2010;184(5):1907–13.PubMedCrossRefGoogle Scholar
  16. 36.
    Grossman HB, Stenzl A, Fradet Y, Mynderse LA, Kriegmair M, Witjes JA, Soloway MS, Karl A, Burger M. Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy. J Urol. 2012;188(1):58–62.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 37.
    Geavlete B, Multescu R, Georgescu D, Jecu M, Stanescu F, Geavlete P. Treatment changes and long-term recurrence rates after hexaminolevulinate (HAL) fluorescence cystoscopy: does it really make a difference in patients with non-muscle-invasive bladder cancer (NMIBC)? BJU Int. 2012;109(4):549–56.PubMedCrossRefGoogle Scholar
  18. 38.
    Malmstrom PU, Grabe M, Haug ES, Hellstrom P, Hermann GG, Mogensen K, Raitanen M, Wahlqvist R. Role of hexaminolevulinate-guided fluorescence cystoscopy in bladder cancer: critical analysis of the latest data and European guidance. Scand J Urol Nephrol. 2012;46(2):108–16.PubMedCrossRefGoogle Scholar
  19. 39.
    Cauberg EC, Kloen S, Visser M, de la Rosette JJ, Babjuk M, Soukup V, Pesl M, Duskova J, de Reijke TM. Narrow band imaging cystoscopy improves the detection of non-muscle-invasive bladder cancer. Urology. 2010;76(3):658–63.PubMedCrossRefGoogle Scholar
  20. 40.
    Bryan RT, Billingham LJ, Wallace DM. Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder. BJU Int. 2008;101(6):702–5.PubMedCrossRefGoogle Scholar
  21. 41.
    Geavlete B, Jecu M, Multescu R, Geavlete P. Narrow-band imaging cystoscopy in non-muscle-invasive bladder cancer: a prospective comparison to the standard approach. Ther Adv Urol. 2012;4(5):211–7.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 42.
    Geavlete B, Multescu R, Georgescu D, Stanescu F, Jecu M, Geavlete P. Narrow band imaging cystoscopy and bipolar plasma vaporization for large nonmuscle-invasive bladder tumors—results of a prospective, randomized comparison to the standard approach. Urology. 2012;79(4):846–51.PubMedCrossRefGoogle Scholar
  23. 43.
    Herr HW, Donat SM. A comparison of white-light cystoscopy and narrow-band imaging cystoscopy to detect bladder tumour recurrences. BJU Int. 2008;102(9):1111–4.PubMedCrossRefGoogle Scholar
  24. 44.
    Tatsugami K, Kuroiwa K, Kamoto T, Nishiyama H, Watanabe J, Ishikawa S, Shinohara N, Sazawa A, Fukushima S, Naito S. Evaluation of narrow-band imaging as a complementary method for the detection of bladder cancer. J Endourol. 2010;24(11):1807–11.PubMedCrossRefGoogle Scholar
  25. 45.
    Zhu YP, Shen YJ, Ye DW, Wang CF, Yao XD, Zhang SL, Dai B, Zhang HL, Shi GH. Narrow-band imaging flexible cystoscopy in the detection of clinically unconfirmed positive urine cytology. Urol Int. 2012;88(1):84–7.PubMedCrossRefGoogle Scholar
  26. 46.
    Zheng C, Lv Y, Zhong Q, Wang R, Jiang Q. Narrow band imaging diagnosis of bladder cancer: systematic review and meta-analysis. BJU Int. 2012;110(11 Pt B):E680–7.PubMedCrossRefGoogle Scholar
  27. 47.
    Cauberg EC, Mamoulakis C, de la Rosette JJ, de Reijke TM. Narrow band imaging-assisted transurethral resection for non-muscle invasive bladder cancer significantly reduces residual tumour rate. World J Urol. 2011;29(4):503–9.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 48.
    Herr HW, Donat SM. Reduced bladder tumour recurrence rate associated with narrow-band imaging surveillance cystoscopy. BJU Int. 2011;107(3):396–8.PubMedCrossRefGoogle Scholar
  29. 49.
    Naselli A, Introini C, Timossi L, Spina B, Fontana V, Pezzi R, Germinale F, Bertolotto F, Puppo P. A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence. Eur Urol. 2012;61(5):908–13.PubMedCrossRefGoogle Scholar
  30. 50.
    Tilki D, Burger M, Dalbagni G, Grossman HB, Hakenberg OW, Palou J, Reich O, Roupret M, Shariat SF, Zlotta AR. Urine markers for detection and surveillance of non-muscle-invasive bladder cancer. Eur Urol. 2011;60(3):484–92.PubMedCrossRefGoogle Scholar
  31. 51.
    Mansoor I, Calam RR, Al-Khafaji B. Role of urinary NMP-22 combined with urine cytology in follow-up surveillance of recurring superficial bladder urothelial carcinoma. Anal Quant Cytol Histol. 2008;30(1):25–32.PubMedGoogle Scholar
  32. 52.
    Sharma S, Zippe CD, Pandrangi L, Nelson D, Agarwal A. Exclusion criteria enhance the specificity and positive predictive value of NMP22 and BTA stat. J Urol. 1999;162(1):53–7.PubMedCrossRefGoogle Scholar
  33. 53.
    Fradet Y, Lockhard C. Performance characteristics of a new monoclonal antibody test for bladder cancer: ImmunoCyt trade mark. Can J Urol. 1997;4(3):400–5.PubMedGoogle Scholar
  34. 54.
    Feil G, Zumbragel A, Paulgen-Nelde HJ, Hennenlotter J, Maurer S, Krause S, Bichler KH, Stenzl A. Accuracy of the ImmunoCyt assay in the diagnosis of transitional cell carcinoma of the urinary bladder. Anticancer Res. 2003;23(2A):963–7.PubMedGoogle Scholar
  35. 55.
    Mian C, Pycha A, Wiener H, Haitel A, Lodde M, Marberger M. Immunocyt: a new tool for detecting transitional cell cancer of the urinary tract. J Urol. 1999;161(5):1486–9.PubMedCrossRefGoogle Scholar
  36. 56.
    Olsson H, Zackrisson B. ImmunoCyt a useful method in the follow-up protocol for patients with urinary bladder carcinoma. Scand J Urol Nephrol. 2001;35(4):280–2.PubMedCrossRefGoogle Scholar
  37. 57.
    Pfister C, Chautard D, Devonec M, Perrin P, Chopin D, Rischmann P, Bouchot O, Beurton D, Coulange C, Rambeaud JJ. Immunocyt test improves the diagnostic accuracy of urinary cytology: results of a French multicenter study. J Urol. 2003;169(3):921–4.PubMedCrossRefGoogle Scholar
  38. 58.
    Kinders R, Jones T, Root R, Bruce C, Murchison H, Corey M, Williams L, Enfield D, Hass GM. Complement factor H or a related protein is a marker for transitional cell cancer of the bladder. Clin Cancer Res. 1998;4(10):2511–20.PubMedGoogle Scholar
  39. 59.
    Villicana P, Whiting B, Goodison S, Rosser CJ. Urine-based assays for the detection of bladder cancer. Biomark Med. 2009;3(3):265.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 60.
    Quek ML, Sanderson K, Daneshmand S, Stein JP. New molecular markers for bladder cancer detection. Curr Opin Urol. 2004;14(5):259–64.PubMedCrossRefGoogle Scholar
  41. 61.
    Parker J, Spiess PE. Current and emerging bladder cancer urinary biomarkers. ScientificWorldJournal. 2011;11:1103–12.PubMedCrossRefGoogle Scholar
  42. 62.
    Sokolova IA, Halling KC, Jenkins RB, Burkhardt HM, Meyer RG, Seelig SA, King W. The development of a multitarget, multicolor fluorescence in situ hybridization assay for the detection of urothelial carcinoma in urine. J Mol Diagn. 2000;2(3):116–23.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 63.
    Hajdinjak T. UroVysion FISH test for detecting urothelial cancers: meta-analysis of diagnostic accuracy and comparison with urinary cytology testing. Urol Oncol. 2008;26(6):646–51.PubMedCrossRefGoogle Scholar
  44. 64.
    Kipp BR, Karnes RJ, Brankley SM, Harwood AR, Pankratz VS, Sebo TJ, Blute MM, Lieber MM, Zincke H, Halling KC. Monitoring intravesical therapy for superficial bladder cancer using fluorescence in situ hybridization. J Urol. 2005;173(2):401–4.PubMedCrossRefGoogle Scholar
  45. 65.
    Savic S, Zlobec I, Thalmann GN, Engeler D, Schmauss M, Lehmann K, Mattarelli G, Eichenberger T, Dalquen P, Spieler P, Schoenegg R, Gasser TC, Sulser T, Forster T, Zellweger T, Casella R, Bubendorf L. The prognostic value of cytology and fluorescence in situ hybridization in the follow-up of nonmuscle-invasive bladder cancer after intravesical Bacillus Calmette-Guerin therapy. Int J Cancer. 2009;124(12):2899–904.PubMedCrossRefGoogle Scholar
  46. 66.
    Whitson J, Berry A, Carroll P, Konety B. A multicolour fluorescence in situ hybridization test predicts recurrence in patients with high-risk superficial bladder tumours undergoing intravesical therapy. BJU Int. 2009;104(3):336–9.PubMedCrossRefGoogle Scholar
  47. 67.
    Morales A, Eidinger D, Bruce AW. Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol. 1976;116(2):180–3.PubMedGoogle Scholar
  48. 68.
    Lamm DL, Blumenstein BA, Crissman JD, Montie JE, Gottesman JE, Lowe BA, Sarosdy MF, Bohl RD, Grossman HB, Beck TM, Leimert JT, Crawford ED. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol. 2000;163(4):1124–9.PubMedCrossRefGoogle Scholar
  49. 69.
    Bohle A, Jocham D, Bock PR. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol. 2003;169(1): 90–5.PubMedCrossRefGoogle Scholar
  50. 70.
    Han RF, Pan JG. Can intravesical bacillus Calmette-Guerin reduce recurrence in patients with superficial bladder cancer? A meta-analysis of randomized trials. Urology. 2006;67(6):1216–23.PubMedCrossRefGoogle Scholar
  51. 71.
    Malmstrom PU, Sylvester RJ, Crawford DE, Friedrich M, Krege S, Rintala E, Solsona E, Di Stasi SM, Witjes JA. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guerin for non-muscle-invasive bladder cancer. Eur Urol. 2009;56(2):247–56.PubMedCrossRefGoogle Scholar
  52. 72.
    Shelley MD, Kynaston H, Court J, Wilt TJ, Coles B, Burgon K, Mason MD. A systematic review of intravesical bacillus Calmette-Guerin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancer. BJU Int. 2001;88(3):209–16.PubMedCrossRefGoogle Scholar
  53. 73.
    Shelley MD, Wilt TJ, Court J, Coles B, Kynaston H, Mason MD. Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int. 2004;93(4): 485–90.PubMedCrossRefGoogle Scholar
  54. 74.
    Jarvinen R, Kaasinen E, Sankila A, Rintala E. Long-term efficacy of maintenance bacillus Calmette-Guerin versus maintenance mitomycin C instillation therapy in frequently recurrent TaT1 tumours without carcinoma in situ: a subgroup analysis of the prospective, randomised FinnBladder I study with a 20-year follow-up. Eur Urol. 2009;56(2):260–5.PubMedCrossRefGoogle Scholar
  55. 75.
    Duchek M, Johansson R, Jahnson S, Mestad O, Hellstrom P, Hellsten S, Malmstrom PU. Bacillus Calmette-Guerin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study. Eur Urol. 2010;57(1):25–31.PubMedCrossRefGoogle Scholar
  56. 76.
    Sylvester RJ, van der MEIJDEN AP, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168(5):1964–70.PubMedCrossRefGoogle Scholar
  57. 77.
    Zlotta AR, van Vooren JP, Huygen K, Drowart A, Decock M, Pirson M, Jurion F, Palfliet K, Denis O, Simon J, Schulman CC. What is the optimal regimen for BCG intravesical therapy? Are six weekly instillations necessary? Eur Urol. 2000;37(4):470–7.PubMedCrossRefGoogle Scholar
  58. 78.
    Oddens J, Brausi M, Sylvester R, Bono A, van de Beek C, van AG, Gontero P, Hoeltl W, Turkeri L, Marreaud S, Collette S, Oosterlinck W. Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guerin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: one-third dose versus full dose and 1 year versus 3 years of maintenance. Eur Urol. 2013;63(3):462–72.PubMedCrossRefGoogle Scholar
  59. 79.
    Herr HW. Restaging transurethral resection of high risk superficial bladder cancer improves the initial response to bacillus Calmette-Guerin therapy. J Urol. 2005;174(6):2134–7.PubMedCrossRefGoogle Scholar
  60. 80.
    van der MEIJDEN AP, Sylvester RJ, Oosterlinck W, Hoeltl W, Bono AV. Maintenance Bacillus Calmette-Guerin for Ta T1 bladder tumors is not associated with increased toxicity: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial. Eur Urol. 2003;44(4):429–34.PubMedCrossRefGoogle Scholar
  61. 81.
    Rodriguez F, Palou J, Martinez R, Rodriguez O, Rosales A, Huguet J, Villavicencio H. Practical guideline for the management of adverse events associated with BCG installations. Arch Esp Urol. 2008;61(5): 591–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • José L. Domínguez-Escrig
    • 1
    Email author
  • Eduardo Solsona Narbón
    • 1
  1. 1.Servicio de UrologíaFundacion Instituto Valenciano de OncologiaValenciaSpain

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