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Charleston, SC--Patients presenting with bladder cancer pose a difficult question for the urologists who must decide how to treat them. Bacillus Calmette-Guerin (Pacis, TherCys, TICE BCG) is an option to consider before cystectomy in some patients, but knowing when BCG is no longer effective and when to perform cystectomy remains a challenge.
Researchers at the University of Miami led by Mark S. Soloway, MD, reviewed their radical cystectomy database and evaluated patients who received BCG to determine if physicians are waiting too long to perform radical cystectomy after BCG.
"Apparently our clinical staging methods are not accurate," Michael A. Simon, MD, a urologic oncology fellow at the University of Miami, told attendees at the AUA Southeastern Section meeting. "We are clearly waiting too long to treat some of our patients. However, we are currently unable to identify exactly which patients these are. Optimal time to perform cystectomy in this patient population is unknown."
The study showed no significant difference in overall or disease-specific survival (p=.91) in patients treated with cystectomy within 12 months of the first dose of BCG (77% and 82%, respectively) versus patients treated with cystectomy more than 12 months after the first dose of BCG (76% and 80%, respectively). Among those patients who required a cystectomy, the estimated 5-year disease-specific survival was only 69%.
The researchers also found:
"Patients who receive BCG should be appropriately counseled that they remain at risk for disease progression," Dr. Simon cautioned. "We don't have good molecular methods right now to put people in risk categories where we can say, 'this patient needs an early cystectomy and this one doesn't.' "