Bacillus Calmette-Guerin (BCG)

How it works

Intravesical BCG triggers a local immune response, attracting immune cells and provoking an inflammatory reaction within the bladder wall that has antitumour activity against superficial urothelial cancer.

Prescribing in practice

• It is a live organism that can cause local and disseminated BCG infection (BCGosis); traumatic catheterisation, active urinary infection or gross haematuria are contraindications to instillation.
• Should not be used in immunocompromised patients owing to the risk of serious systemic infection.
• Prepare and handle with appropriate precautions and avoid instillation soon after bladder biopsy or resection until the urothelium has healed.

Monitoring

Monitor for persistent fever, systemic symptoms or worsening urinary symptoms suggesting BCG infection, and review urine and cystoscopic findings.

Counselling the patient

• Expect transient bladder irritation and mild flu-like symptoms after instillation.
• Seek urgent medical advice for a high or persistent fever, rigors or symptoms lasting beyond a couple of days.

Evidence & guidelines

Intravesical BCG is established standard care for high-risk non-muscle-invasive bladder cancer in NICE guidance and international urology guidelines.