My father has bladder cancer. How to manage recurrence at 66?

Question

Hi doctor,

My father, aged 66, was treated for bladder cancer last year with TURBT and BCG therapy. His latest cystoscopy report revealed a new 1.5 cm lesion, and urine cytology was again suspicious for malignancy.

He also had mild blood in his urine this week. So my concerns are:

Does this mean the treatment is failing?
Should we discuss starting another round of intravesical BCG or go directly for radical cystectomy now?
Is there a risk that the cancer could have already spread to the kidneys or lungs, and how frequently should we repeat CT scans to monitor any possible metastasis?

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Your father’s new bladder lesion on cystoscopy, along with suspicious urine cytology and visible blood in the urine, does suggest recurrence of bladder cancer despite prior transurethral resection of bladder tumor (TURBT) and intravesical Bacillus Calmette-Guerin (BCG), which is unfortunately not uncommon in non-muscle invasive bladder cancer (NMIBC).

The decision to proceed with another round of BCG or move toward radical cystectomy depends on several factors.

The grade and stage of the recurrent tumor.
The timing of the recurrence after initial treatment.
Your father’s overall health.

In general, if cancer recurs within a year of adequate BCG therapy, it is considered BCG-unresponsive disease, and radical cystectomy is often recommended as it offers the best chance of cure.

If the recurrence is low grade or occurs after a longer interval, repeating intravesical therapy may still be considered. Bladder cancer can metastasize to lymph nodes, kidneys, lungs, and bones, with a higher risk in high-grade or muscle-invasive disease.

Computed tomography (CT) scans of the abdomen, pelvis, and chest are typically performed at baseline and then periodically, often every six to 12 months.

You can discuss with your father's urologist and oncologist whether staging scans should be repeated now to rule out spread before deciding on the next treatment step. Careful follow-up and timely intervention are crucial to achieving the best outcome.

I hope this information is helpful. Please do not hesitate to contact me if you need to know anything else; I would be happy to answer.

Thank you.