BCG treatment for bladder cancer

BCG is given after surgery called transurethral resection of a bladder tumour (TURBT). This surgery removes the bladder tumour. BCG treatment helps to prevent the cancer from coming back and lowers the risk of it spreading to the bladder muscle wall. 

BCG treatment usually starts a few weeks after TURBT, once the bladder heals. Your healthcare team will discuss this with you.

The treatment is given initially once a week for six weeks. This is called the induction course. After that, you may have ongoing BCG treatment for one to three years. These are called maintenance treatments. There is more information about the BCG treatment regimen further down the page.

Like any treatment, BCG treatment has some risks. We have listed some general risks below. Your doctor will explain any risks specific to you and answer your questions.  

Common risks (affecting more than 10 out of 100 people): 

• You may feel bladder discomfort or pain when peeing. This usually lasts for a few hours after each dose.
• You may get occasional mild flu-like symptoms, such as chills, fever, headaches or muscle aches. These can come and go for 1 to 2 days.
• You may pee more often or feel an urge to pee. This can last for a few days. If it continues, we will check for a urinary tract infection (UTI). If you have a UTI, you will need antibiotics and your next BCG dose will be delayed until the infection clears.
• You may see blood, blood clots or debris in your urine. These can come and go over several days.

Less common risks (affecting between 5 and 10 out of 100 people): 

• Some people develop inflammation in the joints (elbows, hands or feet), or in the testes and prostate. Please report any new swelling, pain or discomfort right away as you may need treatment.
• Repeated catheter use may cause narrowing of the urethra. This may make it harder to pass urine.

Rare risks (affecting less than 5 out of 100 people): 

• Some people have ongoing or severe bladder pain after treatment.

Very rare risks (affecting less than 1 out of 100 people):

• BCG treatment can very rarely cause a TB infection, which needs to be treated with special TB medicines. If you feel unwell – especially if you have a cough, chills, muscle aches or a fever that do not get better after 36 hours – go to an Emergency Department (A&E). Please note: If you get a TB infection from BCG treatment, it is not contagious, so you cannot pass it on to other people.

Your options depend on your circumstances. Your hospital doctor will have talked to you about them.

Possible alternatives include:

• Repeated cystoscopy without BCG treatment.
• Clinical trials, if available.

Please talk to your clinical nurse specialist (CNS) or hospital doctor if you would like more information about these options.

• Stop smoking if you can. Smoking increases the risk of bladder cancer coming back. For support, visit the NHS Better Health website.
• Plan time off work. You may need time off work on treatment days, so consider speaking with your employer.
• Use contraception. We don’t know how BCG affects an unborn baby, so use effective birth control during treatment.
• Stop breastfeeding. If you are, we recommend stopping while receiving BCG treatment.
• Avoid having anything to drink for 4 hours before treatment. This will help you to hold the BCG in your bladder. You can eat as normal.
• You should not have flu or Covid-19 vaccinations during the course of your treatment and for one week after. Both vaccines can cause mild flu-like symptoms, which may be confused with BCG side effects.
• Tell your CNS or hospital doctor about any medicines you take regularly. Some medicines, like immunosuppressants and certain antibiotics, can affect the treatment. If you are on antibiotics, your healthcare team may ask you to finish them and wait a week before starting or continuing BCG.
• Contact your healthcare team as soon as possible if you feel unwell or can’t attend your appointment.

• You will have your treatment as an outpatient, so you can go home afterward.
• Your CNS will ask you to empty your bladder for the treatment.
• If you feel unwell or might have a urine infection, you may not receive BCG that day. Please tell your CNS if you have any discomfort when peeing on the day of your treatment. You may need to give a urine sample.
• Your CNS will ask you to lie down on a treatment couch and place lubricating gel in your urethra.
• A catheter will be gently passed through your urethra into your bladder. Any remaining urine will be drained.
• Your CNS will then slowly put about 50 ml of the BCG solution into your bladder through the catheter.
• The catheter will be removed after the treatment is finished.

The treatment takes about 20 to 30 minutes to complete.

• You can go home when you feel ready. Before you leave, we may ask you to book your next appointment so that you can complete your treatment course.
• Hold the BCG solution in your bladder for 2 hours before going to the toilet. This gives it time to work properly.
• When you first use the toilet – and for the next 6 hours – please follow these steps to help prevent the BCG bacteria from spreading to others:
  • Men should sit down to pee – this helps to avoid splashing.
  • Flush the toilet twice after each use.
  • Wash hands with soap and water.
  • If any urine gets on your skin, wash the area right away with soap and water.
• Drink 2 to 3 litres of fluids over the next 2 to 3 days. Avoid alcohol and drinks containing caffeine, such as tea, coffee and cola, as they can irritate your bladder.
• Avoid sex for at least 24 hours after treatment because it can cause discomfort. Use a condom during sex for the duration of the treatment and for one week after finishing.
• If you have pain, you can take your usual pain relief following the instructions on the pack. If the pain doesn’t get better, contact your CNS.
• Any side effects should resolve within 48 hours but occasionally they may last longer than that. If you are worried, contact your CNS for advice.