title: Long-term follow-up of intravesical bacillus Calmette-Guérin treatment for superficial transitional-cell carcinoma of the bladder involving the prostatic urethra.
abstract: BACKGROUND
  Intravesical bacillus Calmette-Guérin (BCG) is a treatment option for superficial (<or=T1) transitional cell carcinoma. Transitional cell carcinoma involving the prostatic urethra presents a treatment dilemma. Whereas prostatic urethral involvement might require radical cystectomy, select patients can be offered BCG and careful surveillance to preserve the bladder. We report long-term experience with BCG in this subset of patients with >5-year follow-up.
  
  
  METHODS
  Twenty-eight patients with high-risk superficial bladder cancer and prostatic urethral involvement were treated with once-weekly BCG for 6 weeks. Patients with prostatic stromal involvement were excluded. Maintenance was not used before 1995. Currently, we use maintenance BCG after induction. Patients were followed by cystoscopy/cytology and repeat biopsy to detect persistent and/or progressive disease.
  
  
  RESULTS
  After 1 or 2 courses of once-weekly BCG for 6 weeks, 64.3% (18 of 28 of patients) exhibited a complete response in the bladder and prostate at their 6-month followup. Of those obtaining a complete response, 55.6% (10 of 18) experienced recurrence. Three recurrences were in the prostate: 1 isolated and 2 associated with multifocal bladder involvement. Twenty-eight percent (8 of 28 patients) underwent cystectomy because of failure of treatment to eradicate superficial disease or disease progression. Disease-specific survival was 89% (25 of 28 patients) at a median follow-up of 7.5 years.
  
  
  CONCLUSIONS
  Our long-term data support the durability of intravesical BCG in select patients with superficial bladder transitional cell carcinoma with prostatic urethral involvement. Follow-up biopsy of the prostatic urethra is mandatory and, if positive, cystectomy is indicated. One third of patients will require cystectomy for persistent or progressive disease; therefore, careful surveillance is critical.
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA 23501, USA. intuition97@gmail.com
authors.forename: Jonathan Harris
authors.initials: JH
authors.lastname: Taylor
authors.forename: John
authors.initials: J
authors.lastname: Davis
authors.forename: Paul
authors.initials: P
authors.lastname: Schellhammer
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003558:Cystoscopy; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D014523:Urethral Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine