Eight15,
Guidelines are just that - guidelines. The patient, history and treating physician must all be primary in the decision-making process of how to treat an individual.
Guidelines and expert consensus opinion are medicine's way of describing treatment paths that have been shown to produce repeatable outcomes for SOME portion of the [inadequately] described patient population. That outcome is NOT promised for any individual patient; the guidelines are just a starting point for the consideration of individual treatment options.
As you dig deeper into the works of Dr Donald Lamm and Dr. Mike O'donnell and others, factors such as "how soon LG tumours return" becomes a factor in decision making. The search for biomarkers that might identify those patients at risk for grade advancement are ongoing, and would be a much welcomed discovery.
At about page 13 of the consensus document the long term results of a variety of BCG schedules are discussed and displayed graphically. Although there is debate about the schedules, there are scant actual long term studies published that are conclusive.
Fortunately, we have doctors and care teams to guide us in our battle with BC. If all we had were guideline-driven treatment, some portion of us would likely receive far less than appropriate care.
Other consensus documents exist. The American Urological association and the Canadian Urological Association publish their own. These version dig deeper and evaluate the level of the underlying evidence. And there are thousands of single author publications. Below are links to the two additional association source documents.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4771569/
Yes, I have read too much these past 3 years.
Best,
Jack