Phil.
My diagnosis is somewhat similar. I also still accept everyone is still different. How's that for wishy washy statement!
Anyway, mine was a papillary tumor also. It was small.5CM. My URO also did a second TURB to be sure on the margins. He is going by the basic playbook. He was stunned when the path report came back grade 3. Eyeball he was almost certain it was G1. Thus, the re-TURB. It did read stage 1-lamina propria-no muscle.
I have done BCG, one group of 6 then a cysto 6 weeks later, with a follow up group of 6. Have had 3 cystos since all clear and clear cytology. There are several protocols with differing reasons for what a URO will do. My URO was actually at UTSA when Dr. Lamm pioneered the BCG. A very few say do one protocol of 6 and your done. A few (from what I have read from our Canadian friends some are on a monthly for a year). A bigger minority have done the 6 and 6 as mine. A bigger group like the 6 plus maintenence as per Dr. Lamm.
Lots of reason for the differing protocols. My URO talks about everytime he does a cysto there are some small risks. My last cysto activated latent bacteria or injected bacteria as I had to take antibiotics for an infection. BCG involves small risk-probably increasing with every instillation. Thus his group doing 6 and 6. I am currently clear a year.
I am linking a Journal of Urology article-you can activate in as a guest. After 2 years the general consensus was maintenence vs. 6 and 6 was about equal. Who really knows? Our bodies are all different and I can find opposite abstracts from on almost every subject on cancer. See:
Editorial Comment: The original regimen for treating urothelial cancer with intravesical BCG instillation was based simply on packaging, since 6 ampules of BCG were provided and the number of weekly instillations was therefore set at 6. Studies documenting the development of an immune response with intravesical BCG suggested that a maintenance regimen might be of value in maintaining prophylaxis, since recurrence and progression occurred notwithstanding promising responses to an initial 6-week instillation. The production of cytokines and lymphokines as well as the induction of T helper cells were enhanced by a 3-weekly “booster” instillation 6 weeks after the last of the 6-week primary course. However, others demonstrated that a monthly instillation maintenance regimen was also effective in preventing recurrence.
The present study documented maximization of a peripheral immune response at 4 weekly instillations to maximize an immune response in those not previously immunized. However, the lymphoproliferative response was assessed in a relatively small number of patients, and it is known that lymphokine and cytokine production may have different patterns of response in terms of time course and dosage. Therefore, more patients will need to be studied and their tumor response to intravesical BCG assessed in relation to their lymphoproliferative response to determine appropriate regimens for BCG treatment. Much remains to be done to determine appropriate regimens and mechanisms such that treatments may be given based on specific reactivities of particular tumors in individual patients.
See for the complete:
www.jurology.com/article/PIIS0022534705667936/fulltext