Microscopic view of bladder cells treated with BCG and chemohyperthermia.

BCG vs. Chemohyperthermia: Which Bladder Cancer Treatment Reigns Supreme?

Jordan Keane in Health & Wellness August 2025 • 4 min read.

"A head-to-head comparison of BCG and chemohyperthermia for high-risk non-muscle-invasive bladder cancer reveals surprising insights."

Bladder cancer ranks as the fourth most prevalent cancer among American men. A significant majority, over 75%, are classified as non-muscle-invasive bladder cancer (NMIBC). While the five-year survival rate for NMIBC exceeds 90%, disease recurrence remains a major challenge.

Following the initial transurethral resection (TUR), nearly half of NMIBC patients face the risk of recurrence, and to a lesser extent, progression to muscle-invasive disease. To mitigate these risks, adjuvant intravesical therapy is often recommended, as highlighted by the European Association of Urology (EAU) guidelines.

Bacillus Calmette-Guérin (BCG) instillation is a well-regarded treatment, often considered more effective than chemotherapy for NMIBC, particularly as a first-line option for high-risk patients. However, its side effects necessitate exploring new chemotherapy agents and device-assisted instillation methods for high-risk patients.

BCG vs. Chemohyperthermia: A Detailed Comparison

Microscopic view of bladder cells treated with BCG and chemohyperthermia.

A recent study published in the Canadian Urological Association Journal compared the effectiveness of Bacillus Calmette-Guérin (BCG) and chemohyperthermia (C-HT) in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). The study retrospectively analyzed data from 1,937 patients diagnosed with bladder cancer between January 2004 and January 2014.

The primary goal was to compare the recurrence-free interval between patients treated with BCG and those treated with C-HT. Here’s a breakdown of the study’s methodology and findings:

Patient Selection: The study included patients with high-risk NMIBC who underwent either intravesical C-HT or BCG instillation. Patients undergoing a second TUR were also included. Specific exclusion criteria were applied, such as reduced BCG dosage, bladder diverticulum size limitations, non-urothelial carcinoma types, and low bladder capacity.
C-HT Procedure: Chemohyperthermia was performed using a bladder wall thermochemotherapy unit with a specialized catheter, involving a combination of mitomycin-C (MMC) and bladder wall hyperthermia maintained at 42.5 to 45°C for 60 minutes.
Follow-up: Patients underwent regular cystoscopies and urine cytology every three months for the first two years, then every six months up to the fifth year, and annually thereafter. Visible lesions were resected, and recurrence was determined through histological confirmation.
Statistical Analysis: Propensity score-matched analyses were conducted to compare C-HT and BCG treatments. Statistical methods, including t-tests, chi-square tests, McNemar tests, and Cox regression models, were employed to evaluate recurrence and progression rates.

The study revealed that BCG significantly improved recurrence-free intervals compared to C-HT. At the 2-year mark, 76.2% of C-HT-treated patients were recurrence-free, compared to 93.9% in the BCG group (p = 0.020). The researchers concluded that C-HT is not as effective as BCG in BCG-naive, high-risk NMIBC patients.

The Bottom Line: BCG Remains the Gold Standard

While newer treatments like chemohyperthermia show promise, this study reinforces that intravesical BCG instillation remains the superior adjuvant treatment for high-risk NMIBC. Patients and healthcare providers should continue to prioritize BCG as a first-line treatment, while ongoing research explores ways to improve and refine alternative therapies.

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Everything You Need To Know

What is the primary difference between BCG and chemohyperthermia in treating high-risk non-muscle-invasive bladder cancer (NMIBC)?

The main difference lies in their effectiveness in preventing recurrence. The study highlighted that Bacillus Calmette-Guérin (BCG) showed significantly improved recurrence-free intervals compared to chemohyperthermia (C-HT). Specifically, at the two-year mark, a higher percentage of patients treated with BCG remained recurrence-free (93.9%) compared to those treated with C-HT (76.2%). This finding underscores the superior efficacy of BCG in this context.

Why is adjuvant intravesical therapy, such as BCG or chemohyperthermia, recommended for non-muscle-invasive bladder cancer (NMIBC) patients?

Adjuvant intravesical therapy is recommended to reduce the risk of recurrence and progression after the initial transurethral resection (TUR). The majority of NMIBC patients face the risk of recurrence, and to a lesser extent, progression to muscle-invasive disease. The European Association of Urology (EAU) guidelines recommend adjuvant intravesical therapy as a measure to mitigate these risks.

How is chemohyperthermia (C-HT) performed in the treatment of high-risk non-muscle-invasive bladder cancer (NMIBC)?

Chemohyperthermia (C-HT) involves a specialized procedure. It utilizes a bladder wall thermochemotherapy unit with a specific catheter. This method combines mitomycin-C (MMC) with bladder wall hyperthermia. The hyperthermia is maintained at a temperature range of 42.5 to 45°C for a duration of 60 minutes. The study compared this procedure to the BCG instillation.

What were the key findings of the study comparing BCG and chemohyperthermia?

The study revealed that BCG significantly improved recurrence-free intervals compared to C-HT. The study found that at the two-year mark, 93.9% of patients treated with Bacillus Calmette-Guérin (BCG) were recurrence-free, while only 76.2% of patients treated with chemohyperthermia (C-HT) were recurrence-free. The researchers concluded that C-HT is not as effective as BCG in high-risk NMIBC patients who have not previously received BCG. This positions BCG as the superior adjuvant treatment.

Considering the study's findings, what are the implications for patients and healthcare providers regarding the treatment of high-risk non-muscle-invasive bladder cancer (NMIBC)?

The study reinforces that intravesical Bacillus Calmette-Guérin (BCG) instillation remains the superior adjuvant treatment for high-risk non-muscle-invasive bladder cancer (NMIBC). Therefore, patients and healthcare providers should continue to prioritize BCG as a first-line treatment. While newer treatments like chemohyperthermia show promise, the current evidence supports BCG's efficacy in preventing recurrence. Ongoing research is crucial to improve and refine alternative therapies, but BCG remains the gold standard based on the study's conclusions.