Abstract

before the 1st and 2nd BCG course was present in 42/57 (74%) and 47/ 57 (82%) patients, respectively, diagnosed with UUT and/or urethral carcinoma. Bladder Tis before the 1st and/or 2nd BCG course was the only independent predictor of UUT and/or urethral carcinoma on multivariable analysis. Of the 110 patients, 69 (63%) were alive at last follow-up visit, 18 (16%) have died due to metastatic urothelial carcinoma, and 23 (21%) have died due to other causes. Pattern of disease recurrence within the urinary tract was not an independent predictor of cancer-specific survival. CONCLUSIONS: UUT and/or urethral carcinoma was detected during long-term follow-up in >50% of our patients with high-risk NMIBC “failing” after 2 induction courses of intravesical BCG. The vast majority of these patients had bladder Tis before the 1st and/or 2nd BCG course. Thus, a diagnostic work-up of UUT and prostatic urethra should always be performed in patients experiencing so-called BCG “failure” in order to exclude urothelial carcinoma before additional intravesical therapy or even a radical cystectomy are offered.

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