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Management of BCG Recurrent Bladder Cancer

  • Tracy M. DownsEmail author
  • Daniel J. Lee
  • Douglas S. Scherr
Chapter

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.

Keywords

BCG BCG-refractory disease Intravesical therapy Radical cystectomy Recurrence Progression Prognostic Cost EORTC Non-muscle-invasive bladder cancer 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Tracy M. Downs
    • 1
    Email author
  • Daniel J. Lee
    • 2
  • Douglas S. Scherr
    • 2
  1. 1.Department of UrologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.James Buchanan Brady Department of UrologyWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA

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