Older Age and Outcomes of Intravesical Bacillus Calmette-Guérin for Non-muscle-invasive Bladder Cancer

Intravesical bacillus Calmette-Guérin (BCG) therapy is the standard adjuvant treatment for high-risk non-muscle-invasive bladder cancer (NMIBC). However, the impact of advanced age, particularly ≥80 years, on oncological outcomes of BCG therapy remains controversial. This study evaluated age-stratified outcomes and real-world BCG delivery in patients with NMIBC.

We retrospectively reviewed 120 consecutive patients with NMIBC who initiated intravesical BCG therapy between June 2019 and May 2025 at a single center. Patients were stratified by age at BCG initiation into <80 years (n=91) and ≥80 years (n=29). High-risk recurrence-free survival (HR-RFS), progression-free survival (PFS), metastasis-free survival (MFS), and overall survival (OS) were assessed. HR-RFS was defined as the time from BCG initiation to recurrence of high-risk NMIBC or disease progression. Survival outcomes were estimated using the Kaplan-Meier method and compared between groups.

Baseline clinicopathological characteristics and the rate of achieving the institution-defined minimum BCG exposure were similar between the two age groups. During a median follow-up of 33.5 months, there were no significant differences in HR-RFS (p=0.803), PFS (p=0.700), MFS (p=0.750), or OS (p=0.065) between the groups. Although HR-RFS was numerically lower in the ≥80 years group, progression to muscle-invasive disease and distant metastasis remained infrequent and comparable between groups.

In this real-world cohort, intravesical BCG therapy achieved comparable oncological outcomes in patients aged ≥80 years and younger patients with NMIBC. Chronological age alone was not associated with inferior clinically meaningful disease control, supporting BCG use in older patients when clinically indicated, with treatment decisions guided by tolerability and patient preference.