Immunological treatment of superficial bladder carcinoma

To determine the effect of intravesical bacillus Calmette-Guerin (BCG) therapy in relation to recurrence of superficial bladder cancer after transurethral resection (TUR).

During the period 1996-2001 patients who underwent TUR were randomized to have adjuvant BCG treatment (intravesically and subcutaneously) (43 patients) or TUR alone (43 patients). Eighteen patients of the latter group were crossed-over to BCG group because of frequent recurrences. These 61 BCG-treated patients were the focus of this report. All of them presented with papillary noninvasive (stage Ta) or superficially invasive (stage T1) tumours (grades 2 and 3), with or without associated carcinoma in situ (Tis).

A total of 19 (31%) patients remain free of tumor, 17 (28%) had superficial recurrences and 25 (41%) had disease progression, first identified as muscle invasion in 12, prostatic involvement in 8 and metastasis in 5. Most tumors recurred or progressed within the first 5 years. Of the 61 patients 33 (54%) are disease-free and with intact bladder, 13 (21%) are disease-free after cystectomy, 2 (3%) died of other causes, 1 (2%) is alive with metastasis and 12 (20%) died of metastatic urothelial cancer.

BCG has been shown to be effective for prophylaxis against tumor recurrence and appears to be more useful in the treatment of patients with Tis. Intravesical BCG in conjunction with TUR may be effective in the treatment of patients with Tis involving the prostatic urethral mucosa. The mechanism by which BCG exerts its antitumor effect seems to be immunologically-mediated. Based upon our current data we believe the potential for long-term bladder preservation, progression-free and overall survival justifies the risk and cost of BCG therapy and frequent follow-up evaluations for most patients with superficial bladder cancer.