Clinical Scenario: Initial CIS

Case: 55-Year-old man with CIS and high-grade Ta tumors who received a 6-week induction course of BCG
  • Sima P. PortenEmail author
  • Colin P. Dinney


Management of patients with intermediate- to high-risk non-muscle invasive bladder cancer (large, multiple tumors, presence of carcinoma in situ, and high-grade disease) is centered on optimal intravesical bacillus Calmette-Guerin therapy. Improvements in technology, such as photodynamic diagnosis combined with traditional techniques of complete resection and thorough staging can improve outcomes. Timely surveillance with cystoscopy is necessary, and urinary markers such as fluorescence in situ hybridization can further help risk-stratify those most likely to fail treatment.


Non-muscle invasive bladder cancer Carcinoma in situ Bacillus Calmette-Guerin Fluorescence in situ hybridization Photodynamic diagnosis 



Bacillus Calmette-Guerin


Carcinoma in situ


European Organization for Research and Treatment of Cancer


Food and Drug Administration


Fluorescence in situ hybridization




Non-muscle Invasive Bladder Cancer


Photodynamic diagnosis


Southwest Oncology Group


Transurethral resection


  1. 1.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Heney NM, Ahmed S, Flanagan MJ, et al. Superficial bladder cancer: progression and recurrence. J Urol. 1983;130(6):1083–6.PubMedGoogle Scholar
  3. 3.
    Sylvester RJ, Brausi MA, Kirkels WJ, et al. 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
  4. 4.
    Sylvester RJ, van der MA, 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
  5. 5.
    Sylvester RJ, van der Meijden AP, Witjes JA, Kurth K. Bacillus calmette-guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials. J Urol. 2005;174(1):86–91. discussion 91–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. 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. discussion 466–477.PubMedCrossRefGoogle Scholar
  7. 7.
    Fernandez-Gomez J, Madero R, Solsona E, et al. 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
  8. 8.
    Lamm DL, Blumenstein BA, Crissman JD, et al. 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
  9. 9.
    Reichert DF, Lamm DL. Long term protection in bladder cancer following intralesional immunotherapy. J Urol. 1984;132(3):570–3.PubMedGoogle Scholar
  10. 10.
    Herr HW. Extravesical tumor relapse in patients with superficial bladder tumors. J Clin Oncol. 1998;16(3): 1099–102.PubMedGoogle Scholar
  11. 11.
    Oddens J, Brausi M, Sylvester R, et al. 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
  12. 12.
    Ramirez-Backhaus M, Dominguez-Escrig J, Collado A, Rubio-Briones J, Solsona E. Restaging transurethral resection of bladder tumor for high-risk stage Ta and T1 bladder cancer. Curr Urol Rep. 2012;13(2):109–14.PubMedCrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Herr HW, Donat SM. Quality control in transurethral resection of bladder tumours. BJU Int. 2008;102(9 Pt B):1242–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Jocham D, Stepp H, Waidelich R. Photodynamic diagnosis in urology: state-of-the-art. Eur Urol. 2008;53(6):1138–48.PubMedCrossRefGoogle Scholar
  16. 16.
    Burger M, Grossman HB, Droller M, et al. Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol. 2013;64(5):846–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Herr HW, Sogani PC. Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol. 2001;166(4):1296–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Lotan Y, Roehrborn CG. Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses. Urology. 2003;61(1):109–18. discussion 118.PubMedCrossRefGoogle Scholar
  19. 19.
    Konety BR. Molecular markers in bladder cancer: a critical appraisal. Urol Oncol. 2006;24(4):326–37.PubMedCrossRefGoogle Scholar
  20. 20.
    Gudjonsson S, Blackberg M, Chebil G, et al. The value of bladder mapping and prostatic urethra biopsies for detection of carcinoma in situ (CIS). BJU Int. 2012;110(2 Pt 2):E41–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Witjes JA, Redorta JP, Jacqmin D, et al. Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations. Eur Urol. 2010;57(4):607–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Kamat AM, Karam JA, Grossman HB, Kader AK, Munsell M, Dinney CP. Prospective trial to identify optimal bladder cancer surveillance protocol: reducing costs while maximizing sensitivity. BJU Int. 2011;108(7):1119–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Bubendorf L, Grilli B. UroVysion multiprobe FISH in urinary cytology. Methods Mol Med. 2004;97:117–31.PubMedGoogle Scholar
  24. 24.
    Sarosdy MF, Schellhammer P, Bokinsky G, et al. Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer. J Urol. 2002;168(5):1950–4.PubMedCrossRefGoogle Scholar
  25. 25.
    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
  26. 26.
    Highshaw RA, Tanaka ST, Evans CP. deVere White RW. Is bladder biopsy necessary at three or six months post BCG therapy? Urol Oncol. 2003;21(3):207–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Kamat AM, Dickstein RJ, Messetti F, et al. Use of fluorescence in situ hybridization to predict response to bacillus Calmette-Guerin therapy for bladder cancer: results of a prospective trial. J Urol. 2012;187(3):862–7.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Mengual L, Marin-Aguilera M, Ribal MJ, et al. Clinical utility of fluorescent in situ hybridization for the surveillance of bladder cancer patients treated with bacillus Calmette-Guerin therapy. Eur Urol. 2007;52(3):752–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Raitanen MP, Aine R, Rintala E, et al. Differences between local and review urinary cytology in diagnosis of bladder cancer. An interobserver multicenter analysis. Eur Urol. 2002;41(3):284–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Hara T, Takahashi M, Gondo T, et al. Discrepancies between cytology, cystoscopy and biopsy in bladder cancer detection after Bacille Calmette-Guerin intravesical therapy. Int J Urol. 2009;16(2):192–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Gayed BA, Seideman C, Lotan Y. Cost effectiveness of fluorescence in situ hybridization in patients with atypical cytology for the detection of urothelial carcinoma. J Urol. 2013;190(4):1181–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Skacel M, Fahmy M, Brainard JA, et al. Multitarget fluorescence in situ hybridization assay detects transitional cell carcinoma in the majority of patients with bladder cancer and atypical or negative urine cytology. J Urol. 2003;169(6):2101–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Urology, MD Anderson Cancer CenterThe University of TexasHoustonUSA

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