Superficial bladder carcinoma treated with bacillus Calmette-Guerin: Progression-free and disease specific survival with minimum 10-year followup

Purpose: Intravesical bacillus Calmette-Guerin (BCG) treatment of high risk superficial bladder cancer has reduced recurrence and progression, and lengthened disease specific survival. However, documentation of treatment durability is limited. Materials and Methods: Between 1981 and 1989, 98 patients with high risk or recurrent transitional cell carcinoma were treated with complete transurethral resection followed by i or more 6-week induction courses of BCG, and were followed through 2000. No maintenance regimen was used. A total of 44 cases were carcinoma in situ plus or minus papillary and 35 were stage T1, which was assigned only if muscularis propria free of tumor was present on the biopsy specimen. Results: Of 98 patients with minimum followup greater than 10 years disease progressed to stage T2 or greater in 27 at a median of 30.7 months (range 1.2 to 143.7), of whom cystectomy was performed in 16, cystectomy for recurrent high risk Ta/T1 disease was required in 10, death from transitional cell carcinoma occurred in 13 at a median of 69.7 months (range 11 to 135), upper tract tumor developed in 13 at a median of 49 months (range 9 to 146) and there was evidence of prostatic urethral involvement in 21. The 10-year progression-free survival was 67%, and progression-free survival with a retained bladder 59%. The total cystectomy rate was 26%, permitting a number of patients to be rendered disease-free. The 10-year disease specific survival was 85%. Conclusions: After complete tumor resection and careful pathological staging intravesical BCG for high risk and/or recurrent superficial bladder carcinoma resulted in overall progression-free and disease specific survival rates that support this bladder sparing strategy. Patients must be followed closely and cystectomy recommended for those with an initial incomplete response after initial therapy or recurrent high risk disease.