After 3 BCG doses, I have fever and burning. Is this normal?

Question

Hello doctor,

I am 64 and was diagnosed with high-grade non-muscle invasive bladder cancer. My TURBT report showed T1 with CIS, and I have started BCG therapy. After three doses, I am experiencing urgency, burning, and low-grade fever. Is this expected, or should BCG be paused?

Also, if recurrence happens, how do doctors decide between repeated BCG versus moving to cystectomy? My urologist mentioned re-TURBT, too. How often is that done?

Should I get a second opinion from an oncologist or stick to the urologist? I am trying to understand how aggressive we need to be in early stages to avoid it becoming muscle-invasive or metastatic.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your concerns are very valid, especially with a T1 high-grade non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ (CIS), which is a high-risk combination that requires careful, often aggressive, management. Your current symptoms, like urgency, burning, and a low-grade fever after three doses of BCG (Bacillus Calmette-Guerin), are common side effects of BCG immunotherapy, particularly in the early phase.

Most patients experience local irritation, and mild systemic symptoms are expected. However, BCG should be paused if fever persists beyond 48 hours, exceeds 101.3° Fahrenheit, or if symptoms become severe, as this signals a more serious reaction or even systemic BCG infection. Be sure to notify your urologist promptly so they can evaluate whether a pause or antibiotic coverage is necessary.

As for treatment decisions:

Re-TURBT (transurethral resection of bladder tumor) is standard in T1 high-grade cases and is usually performed within four to six weeks after the initial TURBT to confirm complete resection and reassess staging.
This is especially important in your case because T1 with CIS carries a high risk of progression.
If recurrence or persistence of high-grade disease or CIS occurs after initial BCG, we can consider a second course of BCG (including maintenance if not already done), especially if the patient responded initially.
However, if the tumor recurs during or soon after BCG (within six to 12 months), or BCG-refractory disease is confirmed, then early radical cystectomy is recommended, as delays will allow progression to muscle-invasive or metastatic cancer.

So, overall, early aggressive management of high-grade NMIBC can prevent progression to invasive disease, which is far more difficult to treat. Staying closely monitored with regular cystoscopies, urine cytology, and imaging, and ensuring a complete BCG induction and possible maintenance therapy is critical to improving outcomes.

I hope this helps.

Thank you.