How can I manage bladder cancer and CKD stage 3 at 66?

Question

Hi doctor,

I am a 66-year-old patient recently diagnosed with bladder cancer after experiencing painless blood in my urine for almost two months.

A cystoscopy and biopsy confirmed high-grade urothelial carcinoma, and my CT urogram showed a 3.2 cm mass on the left lateral bladder wall without obvious muscle invasion. My urologist mentioned that it is stage T1 but high risk and advised intravesical BCG therapy after TURBT.

In addition, I have chronic kidney disease stage 3, with my latest serum creatinine at 1.9 mg/dL and an eGFR of around 42 mL/min/1.73 m², which makes me concerned about tolerating further treatments. My hemoglobin is 10.8 g/dL, and I often feel weak and fatigued.

I also have a history of hypertension for 12 years, controlled on telmisartan 40 mg daily, with my last blood pressure reading at 148/92 mmHg.

My family has a history of colon cancer, which adds to my anxiety about recurrence and spread. I understand that smoking is a major risk factor, and although I quit 10 years ago, I had smoked heavily before that.

Could you please guide me on whether BCG therapy is safe for someone with reduced kidney function, what other treatment options may be available, and how I can monitor for recurrence or progression of my condition?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have been diagnosed with high-grade T1 non-muscle-invasive bladder cancer.

The usual treatment is a complete resection of the tumor, TURBT (transurethral resection of bladder tumor) followed by BCG therapy (Bacillus Calmette-Guérin therapy), which is considered safe even with stage 3 chronic kidney disease, though kidney function should be monitored because rare side effects can affect the kidneys.

A repeat TURBT in four to six weeks is recommended to confirm complete removal and make sure the cancer has not invaded the muscle.

If the tumor comes back or shows higher-risk features, early surgery to remove the bladder (radical cystectomy) may be considered.

If BCG does not work or cannot be tolerated, other treatments like intravesical Gemcitabine or Docetaxel, Nadofaragene Firadenovec, or Pembrolizumab may be options.

Follow-up is very important. After treatment, cystoscopy and urine cytology are usually done every three to four months for the first two years, then every six months for the next two years, and once a year after that.

Imaging of the kidneys and ureters is often done every one to two years. Any fever, chills, or ongoing urinary symptoms during BCG should be reported immediately.

Managing other health issues is also important. Blood pressure should be kept under control, and blood tests for anemia and kidney function should be checked regularly. Avoiding smoking is critical, as past heavy smoking increases the chance of recurrence. Screening for other cancers, like colon cancer, given your family history, should also be kept up to date.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.