Is transurethral biopsy of the bladder necessary after 3 months to evaluate response to bacillus Calmette-Guerin therapy?

PURPOSE: We assessed the need for transurethral biopsy of the bladder at the 3-month evaluation in patients who have received intravesical bacillus Calmette-Guerin (BCG). MATERIALS AND METHODS: A total of 81 patients collectively received 83, 6-week courses of BCG between 1995 and 1997, and underwent transurethral bladder biopsies 3 months after initiation of immunotherapy. The pretreatment and posttreatment bladder biopsy results, urinary cytology and posttreatment cystoscopic findings were correlated. RESULTS: Transitional cell carcinoma was demonstrated in 5 of 11 patients with erythematous bladder mucosa and a positive cytology compared to none of 37 with an erythematous lesion and a negative cytology. Of 12 patients with a papillary lesion on cystoscopy and a positive biopsy 10 had a negative cytology, and only 1 of 13 patients with a negative cystoscopy had a positive biopsy. CONCLUSIONS: Bladder biopsy is not necessary in patients 3 months after receiving BCG who have a normal office cystoscopy or an erythematous bladder and normal urine cytology.