Is bladder biopsy necessary at three or six months post BCG therapy?

Highshaw, Ralph A.; Tanaka, Stacy T.; Evans, Christopher P.; White, Ralph W. deVere

doi:10.1016/s1078-1439(02)00239-9

Cited by 19 publications

(13 citation statements)

References 7 publications

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“…5,6 Fluorescence in situ hybridization (FISH) analysis (UroVysion; Abbott/Vysis, Downers Grove, IL) of exfoliated urothelial cells is highly sensitive and specific for urothelial cancer, regardless of whether the patient is being treated with intravesical immunotherapy. 7 Although FISH has been studied as a surveillance tool, there is limited data assessing the ability of FISH to predict bladder cancer recurrence or progression following initiation of intravesical BCG.…”

Section: Introductionmentioning

confidence: 99%

Use of Fluorescence In Situ Hybridization to Predict Response to Bacillus Calmette-Guérin Therapy for Bladder Cancer: Results of a Prospective Trial

et al. 2012

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Purpose No reliable methods currently exist to predict patient response to intravesical immunotherapy with bacillus Calmette-Guérin (BCG), given after transurethral resection for high-risk non-muscle-invasive bladder cancer. We initiated a prospective clinical trial to determine whether fluorescence in situ hybridization (FISH) results during BCG immunotherapy can predict therapy failure. Materials and Methods Candidates for standard of care BCG were offered participation in a clinical trial. FISH was performed prior to BCG and at 6 weeks, 3 months, and 6 months during BCG therapy with maintenance. Cox proportional hazards regression was used to assess the relationship between FISH results and tumor recurrence or progression; the Kaplan-Meier product limit method was used to estimate recurrence- and progression-free survival. Results One hundred twenty-six patients participated. At a median follow-up of 24 months, 31% of patients had recurrent tumors and 14% experienced disease progression. Patients who had positive FISH results during BCG therapy were 3-5 times more likely than those who had negative FISH results to develop recurrent tumors and 5-13 times more likely to experience disease progression (p < 0.01). The timing of positive FISH results also affected outcome; for example, patients with a negative FISH result at baseline, 6 weeks, and 3 months demonstrated an 8.3% recurrence rate, compared to 48.1% in those with a positive FISH result at all three time points. Conclusions FISH results can identify patients who are at risk of tumor recurrence and progression during BCG immunotherapy. This information may be used to counsel patients about alternative treatment strategies.

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Section: Introductionmentioning

confidence: 99%

Use of Fluorescence In Situ Hybridization to Predict Response to Bacillus Calmette-Guérin Therapy for Bladder Cancer: Results of a Prospective Trial

et al. 2012

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“…CIS can be macroscopically missed during white light cystoscopy 4 . It has been reported that negative cystoscopy findings and normal urine cytology can make it possible to avoid routine biopsies after BCG instillations 5,6 . Nevertheless, few large‐scale, highly accurate analyses concerning evaluation methods have been reported.…”

Section: Introductionmentioning

confidence: 99%

Discrepancies between cytology, cystoscopy and biopsy in bladder cancer detection after Bacille Calmette‐Guerin intravesical therapy

et al. 2009

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Objectives: To evaluate discrepancies in the detection of Bacille Calmette-Guerin (BCG)-resistant bladder cancer by cystoscopy, bladder biopsy and urinary cytology. Methods: Between January 1992 and August 2006, 127 bladder cancer patients underwent a cycle of eight weekly BCG instillations. Four weeks after the last BCG instillation, urinary cytological analysis and cystoscopy with targeted biopsy in addition to eight-nine selected-site biopsies were performed. Results: Biopsy-proven cancer was found in 11/27 (40.7%), 5/42 (11.9%), and 11/58 (19.0%) of positive, suspicious, and negative cytology cases, respectively. Abnormal and normal cystoscopic findings correlated with a biopsy-proven cancer in 13/53 (24.5%) and 14/74 (18.9%) cases, respectively. The combination of a macroscopic cystoscopic suspicion and a positive cytology missed malignant cases in 15.9% of the cases. In 100 cases without biopsy-proven cancer, the rates of denuded urothelium at biopsy in the cases with positive and non-positive cytology were 7/16 (43.8%) and 16/84 (19.0%), respectively Conclusions: According to our study, routine biopsy is recommended in the evaluation of BCG treatment, even if the timing, limitations and disadvantages of the procedure should be taken into account.

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“…5,6,8 These studies did not include isolated upper tract cytologies or prostatic urethral biopsies. Furthermore, the study by Skemp et al was limited by a variable number of biopsies (3)(4)(5)(6)(7), and location sites. 5 Although Guy et al carried out thorough and systematic biopsies, the authors did not carry out biopsies on all patients undergoing treatment with a history of CIS or Ta disease, thereby limiting their results.…”

Section: Discussionmentioning

confidence: 99%

“…To adequately assess the response of intravesical BCG therapy in the treatment of NMIBC, the Southwest Oncology Group began evaluating all patients after intravesical therapy with transurethral bladder biopsies at the time of 3‐month cystoscopy 3 . Many urologists continue this practice of routine bladder biopsy at 3–6 months; however, several authors suggest instead that biopsies only be carried out in select patients based on initial pathology or 3‐month cystoscopy and cytology 4–8 …”

Section: Introductionmentioning

confidence: 99%

“…3 Many urologists continue this practice of routine bladder biopsy at 3-6 months; however, several authors suggest instead that biopsies only be carried out in select patients based on initial pathology or 3-month cystoscopy and cytology. [4][5][6][7][8] It has been our practice to carry out restaging, including cystoscopy, bladder wash cytology, upper tract barbotage cytology, and transurethral bladder and prostate biopsy on all patients 6-8 weeks after completion of intravesical treatment of high-grade NMIBC. We investigated whether random bladder and prostatic urethral biopsies, and individual upper tract cytologies (restaging) provide additional useful clinical detail to cystoscopy and bladder cytology in assessing intravesical therapy response for high-grade NMIBC.…”

Section: Introductionmentioning

confidence: 99%

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Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high‐grade non‐muscle invasive bladder cancer

et al. 2012

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Abbreviations & AcronymsObjectives: To investigate whether random bladder, and prostatic urethral biopsies and individual upper tract cytologies (restaging) provide useful clinical information in addition to cystoscopy and bladder cytology in assessing initial intravesical therapy response for high-grade non-muscle invasive bladder cancer. Methods: We retrospectively reviewed records of all patients who underwent restaging at our institution after treatment for high-grade non-muscle invasive bladder cancer (Ta, T1 and Tis) between January 2000 and October 2009. A total of 78 patients undergoing 116 consecutive restagings were included. The presence of intravesical cancer at restaging was assessed by cystoscopy, bladder wash cytology and random bladder biopsies, whereas ureteral and prostatic urethral disease was determined using upper tract barbotage cytology and prostatic urethral biopsies. Results: Indication for intravesical treatment was carcinoma in situ in 86, high-grade T1 in 16 and high-grade Ta in 14 cases. A total of 48 patients had primary disease and 68 had recurrence. Overall, 59 of 116 (50.9%) restagings showed positive bladder or prostatic biopsy and/or a positive cytology localized to the upper tract. Of the total number of recurrences, 12.9% (15 of 116) showed a negative cystoscopy and negative bladder cytology, and would have been missed on routine surveillance. A total of 23 of 116 (19.8%) restagings showed evidence of prostatic urethral and or ureteral disease. Conclusion: Roughly 25% of high-grade non-muscle invasive bladder cancer early recurrences after induction intravesical therapy would go unnoticed without the addition of random and directed prostate biopsies, and isolated upper tract cytologies to standard cystoscopy and bladder cytology.

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Is bladder biopsy necessary at three or six months post BCG therapy?

Cited by 19 publications

References 7 publications

Use of Fluorescence In Situ Hybridization to Predict Response to Bacillus Calmette-Guérin Therapy for Bladder Cancer: Results of a Prospective Trial

Use of Fluorescence In Situ Hybridization to Predict Response to Bacillus Calmette-Guérin Therapy for Bladder Cancer: Results of a Prospective Trial

Discrepancies between cytology, cystoscopy and biopsy in bladder cancer detection after Bacille Calmette‐Guerin intravesical therapy

Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high‐grade non‐muscle invasive bladder cancer

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