BCG

Question 1

___% of patients with bladder cancer are diagnosed with non-muscle invasive disease

Answer 1

70%

Question 2

Up to ____% of NMIBC recurs after treatment

Answer 2

70%

Question 3

5 year survival rate for NMIBC

Answer 3

88%

Question 4

5 year survival rate for MIBC

Answer 4

<60%

Question 5

Smoking leads to ___ recurrence rates and risk of death from bladder cancer

Answer 5

increased

Question 6

BCG should be used as adjuvant therapy for T_, T_, and ____ after TURBT

Answer 6

Ta, T1, and CIS

Question 7

Intravesical BCG reduces both disease ____ and ____

Answer 7

recurrence and progression

Question 8

Induction & Maintenance regimen for BCG

Answer 8

Induction - 6 weekly doses

Maintenance - 7 courses of 3 weekly doses at 3, 6, 12, 18, 24, 30, 36 after negative surveillance cystoscopies

Question 9

SWOG studies

1991 - BCG vs ____ with improved response rates and decreased recurrence

8507 - BCG vs ____ with increased time to recurrence

Answer 9

BCG vs Intravesical doxorubicin

BCG maintenance vs no maintenance

Question 10

Guidelines

Low risk - ___ BCG
Intermediate risk - ___ BCG
High risk - ____ BCG

Answer 10

Low = no bcg
Intermediate = offer bcg
High = induction & maintenance

Question 11

Unclear benefit of one BCG strain over another… all strains are ____ than intravesical chemotherapy

Answer 11

better

Question 12

Unclear benefit of one BCG strain over another… all strains are ____ than intravesical chemotherapy

Answer 12

better

Question 13

BCG Shortage Guidelines

Low risk = ___ BCG
Intermediate risk = ____ BCG
High risk = ___ BCG

Answer 13

Low = NO BCG
Intermediate = 2nd line BCG, use alternative intravesical chemoi instead
High risk = Induction prioritized over maintenance, use Mitomycin if BCG not available

Question 14

BCG is generally given at least ____ s/p TURBT

Answer 14

1 week

Question 15

Minimize ____ prior to BCG administration to reduce dilutional effect

Answer 15

fluid intake

Question 16

Intravesical BCG will lead to PPD conversion in ___% of patients

Answer 16

50%

Question 17

Active ____ infection with a positive PPD is a contraindication to BCG therapy

Answer 17

TB

Question 18

Absolute Contraindications to BCG

1. Active ___ infection
2. _____
3. Traumatic ____

Answer 18

1. UTI
2. Gross Hematuria
3. Catheterization

Question 19

BCG ____ be given to immunocompromised patients

Answer 19

can

Question 20

Concern for UTI after BCG therapy should occur after ____ hrs of LUTS & a urine culture should be obtained

Answer 20

24-48 hrs

Question 21

A course of ____ is effective for severe LUTS s/p BCG in refractory patients

Answer 21

oral steroids

Question 22

Risk Stratification

High grade Ta, <3 cm = ___
High grade T1 = ____

Answer 22

HG Ta <3m = Intermediate

HG T1 = High

Question 23

Risk Stratification

Low grade Ta, <3 cm = ____
Low grade Ta, >3 cm = ____
Multifocal low grade Ta = ___
Recurrent high grade Ta = ____

Answer 23

LG Ta <3 = low
LG Ta >3 = intermediate
Multifocal LG Ta = intermediate
Recurrent HG Ta = high

Question 24

Risk Stratification

Low grade T1 = ____
Low grade Ta, recurred <1 yr = ____
High grade Ta, >3cm = _____
CIS, BCG failure, variant histology, LVI, prostatic urethral disease = ___

Answer 24

LG T1 = intermediate
LG Ta, <1 yr recur = intermediate
HG Ta >3cm = high
CIS = high