Window before RC

[SJay]

Hi All

First post!
I’ve been diagnosed with a T1G3 bladder cancer (superficial high grade). At the first TUR in November they removed two lesions. In December I had a second TUR (their standard protocol is to do two). They found a new lesion and removed that as well as resecting the original two sites. The pathology on the original lesions was good. I’ve got BCG scheduled to start at the end of January and the doctor will scope me first. My concern is that if he finds a new lesion he wants to go directly to an RC.

My question is, how much of a window is there before doing an RC? That is, if there is a new lesion how much risk would I be taking by having another resection and holding off on the RC? If you have any experience with this or know of any resources I could use I would appreciate knowing about it. Thanks!

[Greg]

SJay:
Glad you posted. I was also diagnosed seven years ago with T1G3 BC and had 6 resections over a three year period, interspersed with BCG and Mitomycin C treatments. All went well during that time, but the aggressive tumours seemed to like taking up residence in my bladder. In year 3, though this happens to only about 20% of the bladder cancer population, my disease progressed to muscle invasive disease and an RC became imperative.

Who is your doctor in Vancouver? There are some exceptional ones there and their advice would be really valuable. If you are having an RC in the future, a couple of names come to mind whom I would be seeking out.

Certainly this is not a disease to take a “wait and see” attitude about (not suggesting that you are, but I completely understand a reticence to have an RC). HIgh grade tumours have a nasty habit of recurring and since they grow quickly, muscle invasion is a serious risk. One not worth taking! Trust me.

Greg

[marysue]

Hi Sjay!

Welcome to our site but we know that you wish that you didn’t have need of us. Greg’s advice is to be taken to heart. He is one of our “more experienced” members in this department.

I was diagnosed twice (2008 and 2010) with TaG3 tumours. The difference between you and me is that my tumors were very very superficial whereas yours if they are T1 have gone into what is called the lamina propria – the area just under the top surface of the bladder. A second TURBT is getting to be more and more of the standard way to go especially if it was first diagnosed as a T1. He is doing that to make sure that there was no error and that it isn’t a T2 muscle invasive. Being a high grade cancer you can’t mess around. Some docs will let T1 patients try BCG first and then recommend an RC if it keeps coming back, others recommend go straight to an RC. Your uro is the best judge of what is going on and his advice will need to be given serious consideration. You will need to have a heart to heart with him about the risk of muscle invasion in your case.

I haven’t had to do the RC route but there are lots here including Greg that have so if it becomes the choice you have to make then please don’t hesitate to ask questions. The gang here can give you the low down on what to expect. I’ve done 21 BCGs and could probably write a book about it so if you do have any questions about that if that is the route you will be going, feel free to contact me. Take care and let us know how it goes.

[SJay]

Thanks for the replies.
My urologist mentioned going straight to an RC as one option, but still thought BCG was the best choice at this time.
Greg, my urologist is Dr. Alan So who works out of the Vancouver Prostate Centre at VGH.

[Greg]

SJay:
Dr So was one of the two uros I was thinking about. As Magnum says, you are in excellent and experienced hands.

Greg

[Author]

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