BCG Immunotherapy Versus Radical Cystectomy in Intermediate or High-Risk Non-Muscle Invasive Bladder Cancer Patients - Expert Commentary

Treatment options available for intermediate or high-risk non-muscle invasive bladder cancer include intravesical Bacillus Calmette-Guerin (BCG) and radical cystectomy.

A recent study published by Jian et al. in Medicine compared recurrence rates and adverse events following radical cystectomy or BCG immunotherapy in Chinese patients with intermediate or high-risk non-muscle invasive bladder cancer. The authors also studied clinical decision-making for treatment strategies and calculated the cost of diagnosis, treatment, and follow-up. In this retrospective study, the authors included 312 patients diagnosed with non-muscle invasive bladder cancer. Of these, 210 received BCG, and 87 underwent radical cystectomy.

The most frequent adverse event following BCG treatment was cystitis. Ileus was the most common adverse event following radical cystectomy group a few days after the surgery. Patients were followed for two years. During the follow-up period, the total cost for BCG treatment was higher than the radical cystectomy (P<.0001).

The study has several limitations. The follow-up period was short, and the assignment of patients to the BCG or cystectomy groups was affected by several clinical variables, which could have compounded treatment effects and the observed adverse event profiles. Furthermore, the cost estimates may not be generalizable to other settings. The authors call for prospective randomized trials to directly compare the two treatment strategies.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York


1. Jian, Xiaoming, Mingkang Shen, and Guodong Liao. "Definitive BCG immunotherapy versus radical cystectomy in intermediate or high-risk nonmuscle invasive bladder cancer patients: A retrospective study." Medicine 98, no. 36 (2019).

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