Does BCG maintenance therapy help with NMIBC in the elderly?

Question

Hello doctor,

I am 67 and had TURBT for non-muscle invasive bladder cancer last month. I have completed a 6-week BCG induction course, and my urologist now recommends maintenance therapy.

Is there strong evidence that maintenance of BCG improves survival or reduces recurrence? What side effects might occur with prolonged use? Can it affect my kidneys or cause a systemic infection? Also, if recurrence happens despite this, what are the next treatment options? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Maintenance therapy with Bacillus Calmette-Guérin or BCG (a weakened bacteria used as a vaccine and bladder cancer treatment to boost the immune response), is a well-established approach for managing non-muscle invasive bladder cancer or NMIBC (a type of bladder cancer that has not spread into the bladder's muscle layer). After completing the initial six-week induction phase, many patients continue with maintenance BCG instillations over several months or years to lower the risk of cancer recurrence and progression. Clinical studies have shown that maintenance therapy can significantly improve long-term outcomes in suitable patients.

However, prolonged BCG treatment can lead to side effects. Common local effects include urinary urgency, burning or discomfort during urination, and occasional blood in the urine. Systemic symptoms may involve low-grade fever, fatigue, and flu-like muscle aches. Though rare, serious complications such as systemic BCG infection (which may cause fever, lung inflammation, or liver issues) can occur and need prompt medical attention.

Despite maintenance therapy, some patients still face recurrence or even progression to muscle-invasive disease. The therapy reduces the risk but does not completely eliminate it. If recurrence occurs, further treatment options may include additional intravesical therapies, surgery, or systemic treatments, depending on the cancer's behavior.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.