Does the probiotic L. casei help prevent recurrence after transurethral resection for superficial bladder cancer?
Michael A O'Donnell
Correspondence University of Iowa, Department of Urology, 200 Hawkins Drive, 3 RCP, Iowa City, IA 52242-1089, USA
Email michael-odonnell@uiowa.edu
A randomized clinical trial conducted in Japan compared standard intravesical epirubicin alone with epirubicin plus 1 year of oral Lactobacillus casei strain Shirota in patients who had undergone resection of intermediate-risk, non-muscle-invasive bladder cancer. A statistically significant 
15% absolute reduction in long-term tumor recurrence was seen in the group that received the oral probiotic; however, as the dropout rate was nearly 3.5-fold greater in the probiotic group, and as neither the treating doctors nor their patients were blinded to the assigned treatment, uncertainty remains as to the reliability of the findings. Also unknown is whether other probiotics would provide similar results and whether these agents would provide benefits in conjunction with other intravesical chemotherapeutic drugs. At this time, while physicians should not necessarily promote the use of probiotics, neither should they discourage their patients from trying what could amount to a much-needed boost to the efficacy of conventional intravesical chemotherapy.
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