Hello Dr. Lamm,
I trust you are doing well. I have a couple of questions that I'm hoping you can help me with. I was originally diagnosed with T1 with CIS (12/2010) after having a 3 cm papillary tumor resected in 11/2010. I have since had the 6 week BCG induction series and 3, three week maintenance instillations of BCG the last of which was completed on 3/15/2012. I have been cancer free thus far with no recurrences since 3/2011. My next Blue Light Cysto is scheduled for 6/21/2012. To date, the only tests I have had at my quarterly Cystos are Cytology, one PSA & a biopsy at my last Cysto. Would you recommend anything additional at this juncture? i.e. Upper & lower ureter check, Prostate & Prostate Ureter check, C/T Pylogram, retrogrades, washes, kidney check, etc.
As you imply, it is important to also follow the upper tracts and prostate in CIS and high grade disease. I once recommended annual upper tract evaluations, but if the bladder remains clear and cytologies and fish are negative, I think this is too much (even potentially carcinogenic).
A CT
urogram or retrograde at 1-3 years would be good. I like to do a fish when extending the intervals between cystoscopy (or at any time I am worried about recurrence). At cysto I routinely wash the prostatic urethra, but a F/U biopsy of the prostate is also good. This, plus retrogrades and ureteral washes makes for a good certainty that there is no occult disease. Again, every 1-3 years is in the ballpark.
My second question relates to the strength of my BCG maintenance dosages. To date, I have been getting full strength but I have read that reduced dosages-i.e. 33%-might be advisable and even more effective so as to not hinder the immune response and/or in order to prolong the ability to tolerate the
BCG. Full strength is fine if you are tolerating it, but most patients have increasing symptoms that need to be moderated by reduced dose.
Best, DL
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