Is transurethral biopsy of the bladder necessary after 3 months to evaluate response to bacillus Calmette-Guerin therapy?

Purpose: We assessed the need for transurethral biopsy of the bladder at th e S-month evaluation in patients who have received intravesical bacillus Ca lmette-Guerin (BCG). Materials and Methods: A total of 81 patients collectively received 83, 6-w eek courses of BCG between 1995 and 1997, and underwent transurethral bladd er biopsies 3 months after initiation of immunotherapy. The pretreatment an d posttreatment bladder biopsy results, urinary cytology and posttreatment cystoscopic findings were correlated. Results: Transitional cell carcinoma was demonstrated in 5 of 11 patients w ith erythematous bladder mucosa and a positive cytology compared to none of 37 with an erythematous lesion and a negative cytology. Of 12 patients wit h a papillary lesion on cystoscopy and a positive biopsy 10 had a negative cytology, and only 1 of 13 patients with a negative cystoscopy had a positi ve biopsy. Conclusions: Bladder biopsy is not necessary in patients 3 months after rec eiving BCG who have a normal office cystoscopy or an erythematous bladder a nd normal urine cytology.