Al,
That's a tough question. I think some docs think keep trying to save the bladder until it's clear they can't. Once it invades the muscle wall, then they will mostly all agree it's time to take it out.
They remove the prostate during the RC surgery. Even with nerve sparing, it can take from one to three years before erections can happen again just because of that. There are pills and shots and things that can be used to address that problem in the mean time but it is something to consider.
Of course, when you are facing the chance of cancer spread, the above problem certainly drops on the priority list.
Given that they have to take a bunch of tumors out each time, it seems like recovery time after each one could be a bit of an issue also for you so that would certainly weigh in the decision.
Personally, when my bladder cancer came back after 2 years, I decided I was going to the get the surgery even if it wasn't invasive. I had failed BCG and Mitomycin treatments so my thinking was get it out and eliminate the chance of recurrence. Turned out that it was invasive in my case so the consensus was removal anyway.
If they are doing surgery every six weeks, it seems unlikely (don't forget I am a patient and not a doctor) that you still have 3 years left before it's time to remove it.
What are the different recommendations that the docs (including MD Anderson) are making and what are their reasons/assumptions to support those recommendations.
Mine was CIS which is very aggressive. If yours is not aggressive, then they make agree it will come back but they must be assuming that they won't have to keep removing 5-7 tumors every six weeks.
Mike