| Abstract: |
Bacillus Calmette‐Guerin(BCG) has been shown in randomized trials to be the most effective agent against superficial bladder tumors. BCG therapy prevents or reduces tumore recurrences, abrogates tumor progression and improves survival over surgery alone. The optimal BCG schedule varies among patients, reflecting a heterogeneous tumor population. Multifociality, high grade (G2,3)and T1 tumors are risk factors for tumor recurrence or invation. Patients presentign with such features are most likely to benefit from BCG. An incomplete response to BCG portends a high risk of tumor progression. Non responders have a 40–60% risk of developing muscle invasion or metastases within 10 years, compared with 10–15% for BCG responders. Further, 80% of non‐responders progress in the bladder within 3–5 years. After 5 years, replases are more common in the prostate (13–15%) and upper collecting system (15–33%); one half of these are invasive tumors. This suggests that intense therapy directed at premalignant and early bladder lesions coupled with a chemoprevention strategy designed to protect the whole urothelium will be required to reverse a panurothelial tumor diathesis. © 1992 Wiley‐Liss, Inc. Copyright © 1992 Wiley‐Liss, Inc. |
