Effect of advanced age on the development of complications from intravesical bacillus Calmette-Guérin therapy

Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Guérin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age.

We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma. Patients ranged in age from 51 to 92 years (mean 72.4). Age and BCG-related complications warranting discontinuance of therapy were documented.

In our patient population, 22 of 58 (37.9%) patients experienced complications. The complication rate for patients <70 years old on intravesical BCG maintenance therapy was 17.6%. Patients >or=70 years old had a complication rate of 48.6%. Excluding patients taking anticoagulants, the complication rate in patients age 70 and older was 53.3%. Patients who had complications (mean age 76.0 years) were significantly older than those who had no complications (mean age 70.3 years) (P < 0.00001). The peak incidence of complications occurred with the third BCG course.

Maintenance BCG therapy should be given with caution in patients over age 70 and should be avoided in patients over age 80. Elderly patients at high risk for TCC recurrence and progression may be better served with a single 6-week course of BCG or alternative intravesical agents. Anticoagulants may be somewhat protective against complications in elderly patients but have been shown to significantly decrease the effectiveness of intravesical BCG, further supporting the consideration of alternative agents.