Treatment After BCG Failure in Male Non-Muscle-Invasive Bladder Cancer with Carcinoma In Situ of the Prostatic Urethra
In male patients with non-muscle-invasive bladder cancer (NMIBC), carcinoma in situ (CIS) involving the epithelial lining of the prostatic urethra marks a very high-risk subgroup. When initial intravesical therapy does not achieve the required response, a defined next-line pathway applies.
Male sex with NMIBC and CIS in the epithelial lining of the prostatic urethra. Patients in this setting are classified in the very high-risk group. Intravesical BCG instillation can reach this site; transurethral resection or laser enucleation of the prostate can improve BCG contact with the prostatic urethra.
The prior line used transurethral resection of the prostate followed by full-dose intravesical BCG (induction and maintenance). This protocol applies when those goals were not met:
• Carcinoma in situ still present on prostatic urethra biopsy at 3 months
• Urine cytology positive for high-grade urothelial carcinoma at 3 months
When intravesical BCG is unresponsive, radical surgery is considered for eligible patients. The full protocol specifies the criteria and structured management pathway.
References
All patients with CIS in the prostatic urethra, with certain subtypes of UC, or with LVI, should be included in the very high-risk group.
Patients with CIS in the epithelial lining of the prostatic urethra can be treated by intravesical instillation of BCG.
Transurethral resection or laser enucleation of the prostate can improve contact of BCG with the prostatic urethra.
Radical surgery should be considered.
Offer an RC to patients with BCG-unresponsive tumours.
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