Bacillus Calmette-Guerin (BCG) for Bladder Cancer

How It Works

It is not clear how Bacillus Calmette-Guerin (BCG) works to treat bladder cancer. It may stimulate an immune response or cause inflammation of the bladder wall that destroys cancer cells within the bladder. BCG may be used to treat early-stage cancer, but it is used most commonly to prevent the return (recurrence) of noninvasive bladder cancer. It is most often used after cancer has been removed from the bladder using transurethral resection (TUR) surgery.

BCG is also used in some countries as a vaccine to provide protection against tuberculosis (TB).

When it is used to treat bladder cancer, BCG is given through a urinary catheter (intravesically) into the bladder.

• Limit your fluid intake for 4 hours before the procedure, so you will be able to hold the medicine in your bladder during the treatment.
• BCG is given through a urinary catheter. You will be asked not to urinate for 2 hours and to change position every 15 to 20 minutes so the medicine washes the entire bladder wall.
• For 6 hours after treatment, wash your genital area after every urination to avoid skin irritation.
• Treatment is usually given once a week for 6 weeks. After this, you may be treated again every month for 6 to 12 months or every 3 to 6 months over the next 2 years.

Why It Is Used

BCG is used following TUR surgery for noninvasive bladder cancer in people who are at medium or high risk for recurrence of cancer. It can also be used following TUR surgery in people who cannot have a cystectomy procedure for bladder cancer, but its usefulness in these cases is limited.

How Well It Works

BCG greatly reduces the chance that cancer will progress after TUR surgery for noninvasive bladder cancer.¹

Side Effects

Side effects from BCG may include:

• Burning or pain with urination, a sense of needing to urinate often, or urinating small amounts often.
• Fatigue, joint aches, skin rash, or fever of less than 101°F (38°C).
• Nausea, vomiting, or loss of appetite.

More severe side effects may include:

• Hepatitis or abscess.
• Inflammation of the lung tissue (pneumonitis).
• For men, inflammation and infection of the prostate, testicles, or epididymis.
• Contraction of the bladder or obstruction of the ureters.
• Allergic reaction to BCG or disseminated tuberculosis.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Research continues to determine the most effective strain of BCG and the best dosage schedule for the treatment of bladder cancer. Dosage schedules vary and are determined by your doctor.

If you have major side effects from BCG treatment, you may need more treatment with antibiotics and corticosteroids.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

1. Sylvester RJ, et al. (2004). Intravesical Bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: A meta-analysis of the published results of randomized clinical trials. Journal of Urology, 168 (5): 1964–1970.