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Management of BCG Recurrent Bladder Cancer

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Management of Bladder Cancer

Abstract

The management of patients who develop recurrence after BCG therapy remains one of the most difficult problems in urologic practice. Because these tumors are potentially lethal, early identification of patients suited for additional intravesical treatment or radical cystectomy (RC) is essential. In 2013 the European Association of Urology defined different categories of unsuccessful treatment with intravesical BCG: BCG failure, BCG refractory, BCG relapsing, and BCG intolerance. In patients who have HG NMIBC recurrence within 3 months of BCG treatment, there is an associated progression rate of 82 % compared to a rate of 25 % for those who were not BCG refractory. Among patients who developed recurrence after two treatments of BCG, up to 80 % of the patients will progress and develop MIBC or metastatic disease. Although RC may offer the best oncologic outcomes in patients who recur and/or progress after BCG treatment, the potential benefits of RC must be weighed against the risk and impact on quality of life. Several options, in the properly selected patient are available other than RC, which include combining intravesical agents such as BCG + interferon, or single-agent therapies (i.e. valrubicin, mitomycin, gemicitabine, and docetaxel). Novel therapies that are showing early promise include nab-Paclitaxel and device-assisted therapies. Proper utilization of these available therapies is dependent on the type of BCG recurrent disease and recognition of which risk is being managed, recurrence or progression.

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Authors and Affiliations

  1. Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA

    Tracy M. Downs M.D., F.A.C.S.

  2. James Buchanan Brady Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY, 10065, USA

    Daniel J. Lee M.D. & Douglas S. Scherr M.D.

Authors
  1. Tracy M. Downs M.D., F.A.C.S.
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  2. Daniel J. Lee M.D.
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  3. Douglas S. Scherr M.D.
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Corresponding author

Correspondence to Tracy M. Downs M.D., F.A.C.S. .

Editor information

Editors and Affiliations

  1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA

    Badrinath R. Konety

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

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© 2015 Springer Science+Business Media New York

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Downs, T.M., Lee, D.J., Scherr, D.S. (2015). Management of BCG Recurrent Bladder Cancer. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_20

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  • DOI: https://doi.org/10.1007/978-1-4939-1881-2_20

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