Risk of continued intravesical therapy and delayed cystectomy in BCG-refractory superficial bladder cancer: An investigational approach

Objectives. To assess the risk of continued intravesical therapy and delaye d cystectomy in the management of superficial bladder cancer refractory to bacillus Calmette-Guerin (BCG) therapy. Methods. We retrospectively reviewed the medical records of 24 patients who underwent an experimental intravesical treatment with BCG plus interferon alpha-2b or valrubicin for transitional cell carcinoma of the bladder. All patients had Stage Tis and/or T1 transitional cell carcinoma and had failed multiple prior courses of intravesical therapy, including at least one cou rse of BCG. Results. Patients were followed up for a median of 28.5 months (range 6 to 48). One patient died of unrelated disease. All other patients were alive a t last follow-up. Fourteen patients with preserved bladder were continuing cystoscopic surveillance: four had no recurrence, five had recurrence limit ed to the mucosa (Ta or Tis) and became free of disease after an additional course of intravesical therapy, and five had recurrent Ta or Tis or positi ve cytologic findings. The remaining 9 patients underwent radical cystectom y. All pathologic specimens showed no evidence of progression to muscle-inv asive disease. Tis of the resected ureters in 6 and involvement of the pros tate in 4 of the 9 patients (three in the urethral ducts and glands and one in the prostatic stroma) were noted. Conclusions. A select group of patients with BCG-refractory transitional ce ll carcinoma and a poor surgical risk for cystectomy may benefit from conti nued intravesical therapy without a significant risk of progression. Howeve r, a cautious approach to this treatment modality is recommended, and very close follow-up is necessary to detect bladder recurrences and involvement of the upper tract and prostatic urethra. UROLOGY 58: 376-379, 2001. (C) 20 01, Elsevier Science Inc.