Intravesical instillations with bacillus calmette-guérin for the treatment of carcinoma in situ involving prostatic ducts.
OBJECTIVE
Bacillus Calmette-Guérin (BCG) has proven its efficacy in the treatment of carcinoma in situ (CIS) of the prostatic urethra. We performed a retrospective study to evaluate the use of intravesical instillations of BCG in patients with carcinoma in situ involving prostatic ducts after complete transurethral resection (TUR).


METHODS
Eligibility for the study was CIS of the prostatic urethra involving prostatic ducts. Previous instillation with BCG was an exclusion criterion. Patients were treated with intravesical BCG Connaught (81 mg) administered once a week, over a 6-wk period. TUR loop biopsies of the prostate were performed only when a macroscopic tumor was present.


RESULTS
In this retrospective study of 11 patients, 8 (73%) presented with macroscopic tumor in the prostatic urethra. Ten patients (91%) had a simultaneous superficial bladder carcinoma. Eight patients (73%) had tumoral involvement of the bladder neck region. After a median follow-up of 27 mo (n=10 patients), the response in the prostatic urethra was 82%, and the response in the bladder due to superficial tumor recurrence was 64%. Two patients with residual ductal disease in the prostatic urethra were subsequently treated with cystoprostatectomy and are currently free of disease. In one of those patients, the cystoprostatectomy specimen did show prostatic stromal invasion. Another patient developed distant metastatic disease and died a few months after diagnosis. Thus, progression was encountered in two patients (18%). Currently, 90% of patients are alive without evidence of disease and 72.7% have benefitted from this bladder preservation strategy.


CONCLUSIONS
Intravesical BCG is a feasible treatment option for patients with CIS involving prostatic ducts. In this retrospective study, bladder preservation was successful in 8 of 11 patients (70%) and there was only one oncologic death. Obviously, these patients need a careful follow-up with cystoscopy and cytology to detect either recurrence or progression and in those with persistent disease after the initial BCG induction therapy, prompt cystectomy is indicated.
Palou Redorta
Juan
J
Department of Urology, Fundació Puigvert, Barcelona, Spain. jpalou@fundacio-puigvert.es
Schatteman
Peter
P
Huguet Pérez
Jorge
J
Segarra Tomás
Joséph
J
Rosales Bordes
Antonio
A
Algaba
Ferran
F
Villavicencio Mavrich
Humberto
H
D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000008:administration & dosage*; D001706:Biopsy; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy; D003558:Cystoscopy; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D014523:Urethral Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine