Benjamin E. Ayres, T.R. Leyshon Griffiths* and Raj A. Persad on behalf of Action for Bladder Cancer (ABC)
Frimley Park Hospital, Camberley, Surrey, *University Hospitals of Leicester NHS Trust, Department of Urology, Clinical
Sciences Unit, Leicester General Hospital, Leicester, and University Hospitals Bristol NHS Foundation Trust, Bristol,

Intravesical BCG is recommended as adjuvant therapy for intermediate-risk and high-risk non-muscle-invasive bladder cancer (NMIBC) in guidelines from the European Association of Urology (EAU), the AUA, the BAUS working in association with the British Uro-oncology Group and the National Comprehensive Cancer Network [1–4]. Meta-analyses show Level 1a evidence that BCG reduces recurrence and progression rates, in a disease where the 5-year probability of recurrence is up to 62% (intermediate-risk NMIBC) and 78% (high-risk NMIBC), and the 5-year probability of progression is up to 6% and 45%, respectively [5]. Despite this evidence, there are still questions over the use of intravesical BCG. Is maintenance therapy required? What is the optimal dose and schedule? Is BCG superior to intravesical chemotherapy in intermediate-risk NMIBC? Will BCG be challenged by device-assisted chemotherapy? In addition, a reduction in disease progression is not universally reported. In this article we explore the data surrounding intravesical BCG and will discuss the areas that remain under debate.