Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations

Purpose: Bacillus Calmette-Guerin (BCG) therapy is considered to be an effe ctive prophylactic and therapeutic agent for high risk superficial transiti onal cell carcinoma of the bladder. Nevertheless, in a select uncommon popu lation of stage Ta grade 3 superficial lamina-free tumors the results of th is treatment have not yet been well established. We evaluated recurrence an d progression rates, and the success of BCG therapy in a population with st age Ta grade 3 transitional cell carcinoma of the bladder. Materials and Methods: Of the 605 patients treated at our institution from 1982 to 1996 for the histopathological diagnosis of primary bladder cancer 32 (5.3%) with stage Ta grade 3 noninvasive primary bladder tumor were trea ted with intravesical instillations of 75 mg. Pasteur strain BCC in 50 mi. saline weekly for 6 weeks. At a followup of 2 to 13 years (mean 58.4 months ) patients were evaluated with urinary cytology, cystoscopy, transurethral resection and random mucosal biopsies. Recurrence, grade and stage progress ion, death and causality were analyzed. Results: Of the 32 patients 9 (28%) responded positively to BCG without rec urrence, while disease recurred as stage Ta in 8 (25%) and TT in 7 (22%), a nd progressed to muscle layer infiltration in 8 (25%). Four patients (12%) died of bladder cancer. The number of tumors at primary resection, gross ex amination, the mitotic index or an association with carcinoma in situ did n ot appear to be predictive factors of progression to muscle invasion. Urine cytology (I to II versus III to IV) appeared to correlate highly with prog ression and BCG response (p <0.001) with excellent sensitivity (1) but low specificity (0.67). Conclusions: Our study demonstrates the high progression potential of stage Ta grade 3 tumors, since nearly 50% recurred and 25% progressed to invasiv e disease. These results may be closely compared with the results of previo us trials of stage T1 grade 3 disease. We suggest that recurrence should be detected at an early stage using long-term followup with strict observance of the surveillance protocols during a minimum 5-year tumor-free period.