Witjes - Figure 61
Conclusion: Take Home Messages
FIG. 61: The “take-home” messages for all of the above are the following: Know the risk profile of your patient and what this means for treatment choice.
- In intermediate-risk patients, if there is no BCG or a BCG shortage, chemotherapy is an alternative. This may results in a few more recurrences, but no more progression or cancer-specific mortality.
- In high-risk patients faced with a BCG shortage try, again, to safely reduce the dose or the schedule. There will be a few more recurrences, but no more progression.
- In high-risk patients where there is no BCG, then intravesical chemotherapy does not appear to be a valid answer. Other immunotherapy is, or was, an interesting development.
- Device-assisted therapies, especially radiofrequency-induced hyperthermia, if available, is another option. Fortunately, new strategies and new drugs are being explored.
- Finally, cystectomy is an option, but probably not in high-grade Ta disease.
