BCG Treatment for Bladder Cancer

Written by Allison Torres Burtka
Medically Reviewed by Nazia Q Bandukwala, DO on April 29, 2025
8 min read

Bacillus Calmette-Guérin (BCG) is the main immunotherapy used to treat early-stage bladder cancer. Immunotherapy uses your immune system to fight cancer.

BCG is a type of intravesical therapy, which means a liquid drug is put directly into your bladder through a catheter (a thin tube), rather than given to you in a different way. 

BCG is a type of live but weakened bacteria that stimulates your immune system to attack bladder cancer cells. The drug is made from a strain of the same bacteria used in the tuberculosis vaccine. In your bladder, BCG activates the immune system cells to attack the bladder cancer cells. 

"It's an immunotherapy meant to generate an immune response to help your body fight bladder cancer," says Song Jiang, MD, PhD, a urologist at Northwestern Medicine. But, he says, "the precise mechanism of BCG is still being investigated … in terms of what type of immune response it's generating. Is it a local immune response or a systemic immune response? The general consensus is that it's probably a combination of both." 

One benefit of BCG is that it targets cancer cells in your bladder and doesn’t have a negative effect on the rest of your body. 

Usually, BCG treatment is given after you have TURBT (transurethral resection of bladder tumor), a procedure to remove any visible cancer from the bladder.

In the first 24 hours after BCG treatment, it’s common to have side effects such as:

  • Flu-like symptoms, such as chills and muscle or joint pain
  • A low-grade fever, or 99 to 100 degrees Fahrenheit
  • Needing to pee more often
  • Pain or a burning feeling when you pee
  • A small amount of blood in your pee
  • Feeling tired

Usually, you can manage these side effects with medications from your doctor or over-the-counter pain relievers.

"The most common side effects of BCG are mostly irritative bladder side effects, so urinary frequency and urgency. Some people have some burning, and some have flu-like symptoms," Jiang says. But "some of the acute symptoms go away as soon as people pee out, or void out, the BCG."

Side effects aren’t necessarily a bad thing, Jiang points out. "If you get treated with BCG and you have zero side effects at all – you don't feel it at all – there's some question of, is it generating that immune response that you want? So there's a balance there," he says.

Bladder spasms after BCG treatment

Sometimes, BCG treatment can cause bladder spasms, when your bladder muscle squeezes suddenly and makes you feel like you need to pee right away. This can lead to urinary incontinence, or loss of bladder control.

"Incontinence can happen because of bladder spasms, which can happen with BCG therapy," but incontinence itself isn’t a common side effect, Jiang says. 

Bladder spasms are fairly common – and they’re generally not something you need to worry about, Jiang says. "It's a nuisance, but bladder frequency and urgency and spasm can be a result of the immune response." 

Tissue in urine after BCG treatment

After BCG treatment, you may pass pieces of tissue in your urine. But it’s not necessarily a direct result of BCG treatment. After people are treated with BCG, "oftentimes they'll pass tissue because their bladder is still healing from surgery," or it could be mucus-like tissue from an infection of the bladder, Jiang says. 

Typically, you’ll have a cystoscopy, a test to examine the inside of your bladder, regularly after BCG treatment. The cystoscopy looks for any cause of tissue passage, Jiang says.

BCG sepsis

A very rare but serious complication of BCG treatment is sepsis, which is a life-threatening emergency. Sepsis happens when your body has an extreme response to an infection, and it causes serious inflammation that can lead to organ failure and death. 

Symptoms of BCG sepsis include a high-grade fever and chills. While a low-grade fever is a normal, common side effect of BCG, you should call your health care provider if you have a fever higher than 101.3 degrees Fahrenheit.

How long do the side effects of BCG treatment last?

The side effects of BCG treatment usually go away in two to three days. And sometimes, they may go away as soon as the treatment is over and you pee out the BCG.

If your side effects last longer than two to three days, call your doctor. Also let your doctor know if your symptoms are severe. 

Do BCG side effects get worse with each treatment?

BCG side effects typically don’t get worse with each treatment, Jiang says. "It's not that the side effects get worse, it's that they don't necessarily improve," and that can be frustrating, he says. 

Because BCG treatment needs to be repeated, you may have the same side effects each time you get the treatment.  If the side effects of BCG treatment are serious, people may stop the treatment.

Long-term side effects of BCG treatment for bladder cancer

Long-term side effects of BCG treatment are rare, but they may include urinary tract infections. 

With BCG treatment, most people "tolerate it fine and don't really have any lingering side effects with it," Jiang says. 

But if you have bladder cancer, your bladder may still be healing, and if you already have some irritative bladder symptoms, the BCG treatments may make them worse, Jiang says.  

Your health care provider will give you some guidelines to help you prepare for your treatment. Usually, this includes avoiding caffeine before treatment and peeing beforehand so that your bladder is empty. 

Health care providers typically recommend "being a little bit dehydrated, so not drinking a lot of water the morning before the treatment, just so that you're not feeling the need to go to the bathroom after getting the treatment," Jiang says. 

It’s important to avoid antibiotics before the treatment. "If you're on antibiotics, that can sort of jeopardize the efficacy of BCG," he says.

Before the treatment, you’ll get local anesthesia to numb the area. Then, during the procedure, a catheter is inserted into your urethra (the hole your urine comes out of) to deliver the BCG to your bladder. Then the catheter is removed, and you’ll need to hold the BCG for as long as you can, up to two hours. 

It’s a good idea to prepare yourself mentally for the feelings of urgency and irritative bladder symptoms you might have during the treatment, Jiang says. 

The first BCG treatment, called induction therapy, is given weekly for six weeks. After that, if the treatment is working, your doctor may prescribe maintenance therapy, to be given once a week for three weeks. 

You may get maintenance therapy for up to three years, every three to six months. You’ll have a cystoscopy regularly so your doctor can see how well your treatment is working.

BCG treatment may not be available everywhere. In recent years, the United States has had a shortage of BCG, so health care providers have been using BCG mostly for people with high-risk bladder cancer, not those with a lower risk, Jiang says. "There's few places where you can actually get the full induction and maintenance course of BCG, so if you can find one of those places, consider yourself very fortunate," he says.

Because the BCG drug that goes into your bladder contains live bacteria, it can be passed to others through your urine and through sex. So you’ll need to take some precautions to avoid infecting anyone else, including where you use the bathroom. 

How long are you contagious after BCG treatment?

In the first six hours after treatment, any urine that you pass contains bacteria that can be contagious. To avoid infecting others, for six hours after your treatment:

  • Don’t use public toilets.
  • When you pee, sit down to avoid splashing.
  • Drink lots of fluids to dilute your urine.
  • Each time you pee, add two cups of bleach to the toilet, close the lid, let it sit for 15 to 20 minutes, and then flush the toilet.
  • If you lose control of your bladder, wash your clothes right away and by themselves, not with other clothes.
  • If you use an incontinence pad, don’t just throw it away. First, pour bleach on it, let it soak in, and put it in a plastic bag before throwing it away.

You should not have sex for a few days after BCG treatment. You should also use a condom or barrier every time you have sex during the course of your treatment. 

About 70% of people with bladder cancer go into remission after BCG treatment. 

"The general thinking is the overall response rate for BCG is probably in the 70 to 75 percent range. People respond pretty well, but there is a subset of folks that are considered BCG unresponsive, that don't respond to BCG," Jiang says.  

For up to 50% of people who get BCG treatment, their bladder cancer may return, or recur. But even if the cancer recurs, it may not progress to more invasive cancer.

For up to 30% of people treated with BCG, their cancer may progress from non-muscle invasive bladder cancer to muscle invasive bladder cancer. 

Still, "you have to take those numbers in light of the fact that it's still the best treatment option that we have," Jiang says. "It’s considered a very effective drug, except for the 20 to 30 percent of folks that don't respond."

BCG treatment is a type of immunotherapy for bladder cancer. It works by inserting a liquid drug into your bladder that fights bladder cancer cells. You might have some early side effects, but most people don’t have lingering side effects. After BCG treatment, because the drug contains live bacteria, you have to be careful not to spread infection to anyone else through your urine or through sex.

How long does it take to recover from BCG treatment?

Usually, you can recover from BCG treatment in two to three days. If your side effects last longer or are severe, call your doctor. Sometimes, your side effects might be from recent surgery or infection rather than from the BCG treatment itself.

What is the survival rate for bladder cancer after 10 years?

For people with high-grade non-muscle invasive bladder cancer, meaning it has not grown into the bladder wall, the 10-year survival rate is 70% to 85%.

How many rounds of BCG do you need for bladder cancer?

Typically, you get BCG treatment weekly for six weeks. This is called induction therapy. Later, you may have maintenance therapy once a week for three weeks, and this may be repeated every few months for up to three years.