Objectives. In this article we describe the long-term follow-up of pat
ients with carcinoma in situ (CIS) of the urinary bladder and examine
whether the extent of CIS, the presence of associated papillary tumors
, or the response to treatment influence the course of the disease. Me
thods. Fifty-two patients with CIS of the bladder, treated in a random
ized prospective study, are described. In 23 patients with concomitant
papillary tumors all macroscopically visible lesions were completely
resected transurethrally (TUR). CIS was histologically confirmed in al
l patients by biopsy, 29 of whom had primary CIS. The patients were tr
eated with intravesical mitomycin, bacille Calmette-Guerin (BCG)-RIVM
or BCG-Tice and followed regularly by urine cytology, cystoscopy, and
biopsy. Results. Complete response was achieved in 65% of the patients
. Of these responders, 24% later had a recurrence of CIS or a superfic
ial tumor and 18% had progressive disease (PD). In the nonresponding p
atients, progression occurred in 67%. In the whole group, PD was seen
in 35% of the patients, and radical cystectomy was performed in 21%. T
he disease-related death rate was 13%. The risk for recurrence or PD w
as not higher in patients with more extensive CIS, defined as three or
more positive biopsy results or when CIS was associated with papillar
y tumors compared to patients with one or two biopsy specimens positiv
e for CIS or CIS alone. Nonresponding patients showed a significantly
higher progression rate and cystectomy rate than responding patients (
P = 0.0012 and 0.008, respectively). Conclusions. CIS of the bladder i
s a malignancy with a poor prognosis, especially in patients not respo
nding after intravesical treatment. Early detection and adjuvant intra
vesical treatment after TUR of concomitant papillary tumors are requir
ed. In patients not responding after intravesical treatment, radical s
urgery is necessary before progression occurs. The number of biopsies
positive for CIS, not the presence of concomitant superficial tumors,
was an indicator for progression or recurrence.