Intravesical Bacillus Calmette-Guerin for Treatment of Superficial Transitional Cell Carcinoma of the Prostatic Urethra in Association With Carcinoma of the Bladder

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Abstract
Between 1981 and 1989, 83 male patients with stages Ta, Tis and T1 transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG). Of 17 patients with carcinoma in situ of the prostatic urothelium 13 had identifiable prostatic ducts and periurethral ductal transitional cell carcinoma was identified in 7. At a median followup of 64 months (range 29 to 90) 12 of 17 patients (70%) had a complete response in the prostatic urethra. Among the 10 patients with mucosal carcinoma without ductal involvement 8 responded as did 4 of the 7 with mucosal and ductal involvement. A total of 9 patients had persistent tumor or recurrence in the bladder or prostate. Two men had recurrence in the prostatic urethra and, due to age and co-morbidity, both were treated by transurethral resection and fulguration. Cystectomy was performed in the remaining 7 patients. Three of 31 patients (10%) whose prostate urethral biopsies were negative before BCG therapy had a positive biopsy afterwards. After treatment with BCG, the actuarial curves for cancer specific, progression-free and overall survivals showed no statistical difference between male patients with an initially positive or initially negative prostatic urethral biopsy. BCG is a reliable agent for initial therapy of superficial prostatic transitional cell carcinoma. Careful followup can identify persistent tumor, recurrences or progression that identifies patients for whom cystectomy is appropriate.