BCG Flashcards
___% of patients with bladder cancer are diagnosed with non-muscle invasive disease
70%
Up to ____% of NMIBC recurs after treatment
70%
5 year survival rate for NMIBC
88%
5 year survival rate for MIBC
<60%
Smoking leads to ___ recurrence rates and risk of death from bladder cancer
increased
BCG should be used as adjuvant therapy for T_, T_, and ____ after TURBT
Ta, T1, and CIS
Intravesical BCG reduces both disease ____ and ____
recurrence and progression
Induction & Maintenance regimen for BCG
Induction - 6 weekly doses
Maintenance - 7 courses of 3 weekly doses at 3, 6, 12, 18, 24, 30, 36 after negative surveillance cystoscopies
SWOG studies
1991 - BCG vs ____ with improved response rates and decreased recurrence
8507 - BCG vs ____ with increased time to recurrence
BCG vs Intravesical doxorubicin
BCG maintenance vs no maintenance
Guidelines
Low risk - ___ BCG
Intermediate risk - ___ BCG
High risk - ____ BCG
Low = no bcg Intermediate = offer bcg High = induction & maintenance
Unclear benefit of one BCG strain over another… all strains are ____ than intravesical chemotherapy
better
Unclear benefit of one BCG strain over another… all strains are ____ than intravesical chemotherapy
better
BCG Shortage Guidelines
Low risk = ___ BCG
Intermediate risk = ____ BCG
High risk = ___ BCG
Low = NO BCG
Intermediate = 2nd line BCG, use alternative intravesical chemoi instead
High risk = Induction prioritized over maintenance, use Mitomycin if BCG not available
BCG is generally given at least ____ s/p TURBT
1 week
Minimize ____ prior to BCG administration to reduce dilutional effect
fluid intake
Intravesical BCG will lead to PPD conversion in ___% of patients
50%
Active ____ infection with a positive PPD is a contraindication to BCG therapy
TB
Absolute Contraindications to BCG
- Active ___ infection
- _____
- Traumatic ____
- UTI
- Gross Hematuria
- Catheterization
BCG ____ be given to immunocompromised patients
can
Concern for UTI after BCG therapy should occur after ____ hrs of LUTS & a urine culture should be obtained
24-48 hrs
A course of ____ is effective for severe LUTS s/p BCG in refractory patients
oral steroids
Risk Stratification
High grade Ta, <3 cm = ___
High grade T1 = ____
HG Ta <3m = Intermediate
HG T1 = High
Risk Stratification
Low grade Ta, <3 cm = ____
Low grade Ta, >3 cm = ____
Multifocal low grade Ta = ___
Recurrent high grade Ta = ____
LG Ta <3 = low
LG Ta >3 = intermediate
Multifocal LG Ta = intermediate
Recurrent HG Ta = high
Risk Stratification
Low grade T1 = ____
Low grade Ta, recurred <1 yr = ____
High grade Ta, >3cm = _____
CIS, BCG failure, variant histology, LVI, prostatic urethral disease = ___
LG T1 = intermediate
LG Ta, <1 yr recur = intermediate
HG Ta >3cm = high
CIS = high
