A 55-year-old man with transitional cell carcinoma (TCC) of the bladder invading the muscularis propria (T2) undergoes radical cystectomy. Ileal conduit urinary diversion is fashioned. Which statement about intravesical BCG therapy is MOST accurate?

• A BCG is indicated for T2 muscle-invasive TCC to prevent recurrence post-cystectomy
• B BCG is used for high-risk non-muscle-invasive TCC (T1, high-grade, CIS) to reduce progression to muscle invasion ✓
• C BCG is the first-line treatment for metastatic TCC of the bladder
• D BCG is indicated only for Ta low-grade tumours after TURBT

Explanation

Intravesical BCG (Bacillus Calmette-Guérin) immunotherapy is the gold standard adjuvant treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), specifically T1 high-grade, high-grade Ta, and carcinoma in situ (CIS), after transurethral resection of bladder tumour (TURBT). It significantly reduces recurrence rates and delays or prevents progression to muscle-invasive disease. BCG is contraindicated and not effective for muscle-invasive (T2+) or metastatic disease; those stages require radical cystectomy or systemic platinum-based chemotherapy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.