Hi,
I don't have mets (or bladder cancer, for that matter) but have been part of a group on behalf of my sister for 8 yrs and have met many folks go through progression from superficial cancer. BSAP may or may not indicate mets, so further testing would be needed to rule it out, most likely a bone scan.
MRIs and PET scans are most accurate (more so than CT) in this setting for finding soft tissue metastases.
From what I've observed the most common sites of mets from superficial blc is to the prostate for men, or the upper tract for both men and women. This is known as 'regional' mets and considered a lot more treatable than if TCC shows up in the liver, bones or lungs. Chemo is used for both regional and distant mets and can actually work, too. Sometimes further surgery is done but only under certain conditions, or if response to chemo is seen. Most times cystectomy is not performed unless there has been total response to chemo.
We have a page about symptoms of metastatic bladder cancer here:
blcwebcafe.org/metatcc.asp
Hope you're worrying for nothing here.
Wendy