excellent local pelvic control of the cancer. High-grade, high-stage bladder cancers must be thought of as a disseminated disease. More systemic, instead of local, therapy will be required to improve survival.
Biological Therapy The best immunological drug is BCG vaccine (used for tuberculosis
vaccination) given by catheter inside the bladder (intravesical) weekly for six consecutive weeks. Cystoscopy and urine cytology with flow cytometry at six weeks after the last dose are used to evaluate effectiveness. If a partial response is seen, that is, fewer lesions are found than previously, another course may be given. BCG is completely effective in more than 60 percent of cases and has been proven to be better than no therapy and cytotoxic drugs.
People who respond completely to BCG not only have fewer superficial tumor recurrences but also develop fewer muscle invasive cancers requiring surgery. They also live significantly longer than non-responders.
BCG toxicity includes temporary local bladder irritation, fever and, in very rare cases, a type of tuberculosis infection that can be treated successfully with antitubercular drugs.
