BCG is an option for treatment only after the initial TURBT has been performed and the pathologist has established a definitive diagnosis. Patients with low-grade, low-stage tumors are usually not given BCG. These patients have periodic cystoscopies performed to screen for tumor recurrence. If the tumor does recur in these patients, they are almost always low-grade, low-stage recurrences that are easily treated.
BCG is mainly aimed at those patients whom we believe are at more risk of tumor recurrence or progression. Patients with higher-grade, higher-stage tumors, patients with multiple low-grade tumors, patients with carcinoma in situ, and patients who have already had a recurrence should consider BCG treatment.