Follow up of patients receiving treatment for superficial bladder cancer with mitomycin C and BCG.

The approach that I have followed for patients with recurrent superficial transitional cell carcinoma of the urinary bladder has generally been to perform a thorough endoscopic evaluation of the bladder with appropriate evaluation of the prostatic urethra as well as the upper urinary tract, and if it is felt that the neoplasm is confined to the bladder (and possibly the mucosa of the prostatic urethra), then all obvious tumor should be resected and a three-month trial of intravesical therapy instituted. Based upon the results presented, the response at the first three-month evaluation has major prognostic importance. Those patients who had no evidence of tumor at this first three-month evaluation were less likely to have a subsequent cystectomy or die of bladder cancer than those who had evidence of persistent tumor. Among the 80 patients who received a treatment course of MMC, 13% of the complete responders compared to 34% of those who failed had a subsequent cystectomy, and among the 55 patients who received BCG, 6% of the complete responders compared to 25% of the failures had a subsequent cystectomy during the follow up interval. Indeed, part of this difference can be explained by the gradual adherence to the philosophy that if there is persistent high grade tumor or a high grade tumor develops following an adequate treatment course of MMC or BCG, cystectomy is indicated in order to avoid the development of a tumor which invades into the muscle.(ABSTRACT TRUNCATED AT 250 WORDS)