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Case Presentation: High Grade Recurrence After BCG for Non-Muscle Invasive Bladder Cancer Case Presentation
Patient Case:
A 70-year-old male patient with a 40 pack-year smoking history presents with gross hematuria. Office cystoscopy showed a 3 cm papillary-looking tumor on the posterior bladder wall. Cross sectional imaging did not suggest any upper tract lesions or evidence of nodal or metastatic disease. His renal function test was satisfactory. He was taken to the operating room for an elective transurethral resection of bladder tumor (TURBT). Histopathological examination suggested high grade (HG) pT1 with carcinoma in situ (CIS) with muscle in the specimen which was absent for tumor involvement. The patient proceeded to a re-biopsy at 4 weeks which was negative for cancer.
He subsequently underwent induction bacillus Calmette-Guerin (BCG) treatment which comprised of 6 weekly bladder instillations which he tolerated well. A cystoscopy at 3 months was negative, but bladder biopsy showed CIS. The physician decided to proceed with 3 weekly maintenance BCG instillations 3 weeks after the bladder biopsy. Subsequent bladder biopsy at 6 months suggested no evidence of tumor and the patient proceeded with maintenance BCG instillations.
Unfortunately, 12 months from the date of diagnosis the patient developed disease recurrence which was histologically confirmed as HG Ta with CIS. Radical cystectomy was recommended in view of BCG unresponsive disease. The patient was adamant that he wanted to pursue a bladder sparing option.
