SWArmy
You asked the magic question - to which all of us would like to know THE answer. How long can we try to control bladder cancer before turning to a radical cystectomy in hopes of removing all of the cancer ?
Bottom line seems to be there is no real answer. There are some suggestions from the experts in the field. In the earlier consensus study, Dr. Lamm suggested that there is a window of about 2 years from initial diagnosis to try other treatments, when BCG failed to do the job. Then it is time to seriously consider an RC, to prevent progression from superficial to invasive and metastatic bladder cancer.
Other considerations can be important. Some individuals are not good candidates for the RC surgery. It also matters the type of BC - high grade, low grade, papillary or CIS.
Being both a poor candidate for an RC and having CIS, I can look to an earlier article from Lamm where he discusses the options, and timing of the decision for a select group. Unfortunately, he winds up describing two possible outcomes, and fails to find a way to sort people by outcome. The article, however, offers insight to making the RC decisions with less that full knowledge for this particular group of individuals.
A summary and link to the full article are found at:
www.ncbi.nlm.nih.gov/pubmed/8573479
There are some surprises in the article.
If we look at a large number of reputable Consensus Documents, there is general agreement that delay in moving to an RC can be a BIG mistake when early treatments fail.
On the positive side, there are increasingly good reports on the newer drugs, such as Keytruda, in treating bladder cancer, when all else fails.
Each of us, individually, want the best outcome for ourselves. There is no strong consideration for, nor guidance about, all of our unique situations other than our treating care teams.
Best
Jack