In situ transitional cell carcinoma involvement of prostatic urethra: Bacillus calmette-guérin therapy without previous transurethral resection of the prostate

Abstract Bacillus Calmette-Guérin (BCG) has demonstrated both the efficacy in patients with carcinoma in situ (CIS) of the bladder and the penetration in the prostate (granulomas) after endovesical treatment. We treated patients with CIS of the prostatic urethra with bladder instillations of BCG without previous transurethral resection to assess the local therapeutic effect. Eighteen patients with CIS of the prostatic urethra (15 multifocal CIS and 15 associated to superficial bladder carcinoma) were treated with endovesical instillations of 81 mg of BCG Connaught weekly for 6 weeks. After a mean follow-up of 31 months, 14 of 18 patients had complete response, 3 had progression (2 in the prostate and 1 in the bladder); diffuse CIS of the bladder persisted in 1 patient. Three patients required cystectomy and 1 underwent palliative transurethral resection. Fifteen patients are alive with no evidence of disease, 2 patients died due to progression of the disease, and 1 is alive with tumor. The presence of CIS in the prostatic urethra can be managed with endovesical BCG as initial treatment with fairly good success. There is no need for transurethral resection, even though a loop biopsy may have to be obtained at the first control examination to make sure there is no stromal invasion.