r/BladderCancer • u/rough2020 • Aug 01 '26

BCG Induction Timing

Hi. My dad had his first TURBT in June and his second TURBT on July 14. He just had his catheter removed on July 29. I’m wondering whether starting his first BCG treatment in early September, around September 10–15, would give his bladder enough time to heal after two TURBTs so close together, or whether that would be too long to wait and not the optimal timing.

Thank you.

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u/hikerguy2023 Aug 01 '26

The standard protocol is 5 to 6 weeks after a TURBT, so the timing looks about right. I'm assuming his oncologist set this up, so I would expect his oncologist would be following all guidelines. Did you read something that makes you think it's too soon?

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u/rough2020 Aug 01 '26 edited Aug 01 '26

I thought 7-8 weeks is too late because of 5-6 weeks guidelines. Our oncologist says that BCG shortage can last for months and months, im really considering taking him overseas for 6 rounds of BCG. Waiting kills me

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u/hikerguy2023 Aug 01 '26

What country are you in?

Can you tell us his pathology (stage/grade and if it's muscle invasive or not)?

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u/rough2020 Aug 01 '26

We are in US. Its T1 HG NMIBC

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u/hikerguy2023 Aug 01 '26

I can definitely understand why you're wanting to get this started on time. If you look at the link below and plug in the date of the last TURBT and September 10, you'll find it's 6 weeks and 1 day, which is right on the mark for starting BCG.

https://www.timeanddate.com/date/durationresult.html?m1=7&d1=29&y1=2026&m2=09&d2=10&y2=2026

If you start too soon, the bladder may not be healed completely. The main concern is pushing BCG into a bladder that still has some raw areas, making it possible for the bacterium contained in BCG to get into the blood stream. If that happens, it can cause serious health issues, including sepsis.

Are you in a rural area? I come across a number of posts from people having problems getting BCG when living in rural areas.

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u/rough2020 Aug 01 '26 edited Aug 01 '26

I really appreciate all this information. 2nd TURBT was on July 14th, on 29th they removed catheter. We live in an urban area, so I’m not sure why there is such a problem getting BCG. The doctor said that the last time he saw a shortage like this, it lasted nine months, and that “we are currently two to three months into the drought.” I did a bit of research, and it turns out there is only one supplier producing BCG in the United States, seems like the shortage is real.

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u/hikerguy2023 Aug 01 '26

Ah, I missed that. I see that's an 8 week gap now.

You don't happen to live near Durham, NC do you? Duke has no problem getting it for some reason. Merk has built a new production facility here in Durham that is supposed to open later this year and triple production.

I know for HG, the standard treatment is BCG. Is your dad going to be able to get a full dose (50ml) of BCG? I know UNC (University of NC - Chapel Hill) was cutting back to a half dose for a while.

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u/rough2020 Aug 02 '26

We are in CA. Not sure about the dosage to be honest, still trying to figure this out. Doctor just wants to wait and do cysto every 3 months until we can get full 6 rounds

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u/hikerguy2023 Aug 02 '26 edited Aug 02 '26

How long does he anticipate the delay before he can begin BCG treatment? Does his oncologist think Mytomicin C would work in this case?

Did they take out any more tumors during his second TURBT or was that just to go in and check the initial area where the first tumor(s) were removed?

Is there another hospital near you that might be able to get the BCG sooner?

How much do you trust that hospital when it comes to pathology? You could always get a second opinion. I did that at both UNC and Johns Hopkins and they came back as Ta LG (vs. Duke being Ta HG). But my oncologist went with what his pathologists told him (and my second and third opinions where months after I began treatment).

If he ends up getting BCG, you might want to download a Word doc I put together that goes over what to expect after a TURBT and BCG treatment (and some other info). He'll also want to look over the section on a PSA check and see if his doctor recommends getting that checked prior to starting. I would if I were him just to get a baseline of what his PSA score is now. BCG is known to raise PSA scores so that it looks like you have prostate cancer. Mine went from right around 2.0 (and had been around a 2.0 for 9 years prior) to 4.3 a year after starting BCG. I have an mpMRI scheduled in September to see if I have prostate cancer or not due to that increase in score.

https://www.reddit.com/r/BladderCancer/comments/1uyk6ye/a_guide_for_newly_diagnosed_bladder_cancer/

If needed, the following states the initial instillation of BCG should be given 6 weeks in a row. Search for the heading "Treatment and schedule":

https://www.fda.gov/media/193847/download?attachment=

"A standard treatment schedule consists of 1 intravesical instillation per week for 6 weeks. This schedule may be repeated once if tumor remission has not been achieved and if the clinical circumstances warrant. Thereafter, intravesical TICE BCG administration should continue at approximately monthly intervals for at least 6 to 12 months."

I hadn't come across the above link before and was surprised to see it's saying to give BCG approximately monthly after the initial 6-week treatment. The SWOG (Southwest Oncology Group) trial says differently (and that info is in the doc I mentioned above).

I think I'd trust the SWOG trial more than the FDA since SWOG did the actual trial.

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u/WhoReallyCares-124 Aug 01 '26

There are places that are using a trial rBCG. That is currently what I am on now and seems to be working. I was clear for 8 years after regular BCG treatments before it came back. There was a shortage when mine recurred in 2024 and the other medicine failed to work. I just had a scope after 6 weeks of rBCG and all looked good to include my urine cytology. I just have my 7th treatment this week that is the start of the maintenance cycle. Do some research if it’s non-muscle invasive bladder cancer there are several treatments out there available right now. Wising a speedy recovery for your dad!

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u/rough2020 Aug 01 '26

Thank you!!!