@dks2500 We were not told of this possibility at Mayo Clinic where my husband had his initial diagnosis and surgery. Perhaps this testing is newer or just not widely accepted yet? I had not heard of it. But then when my husband went onto Keytruda, I asked the urologist about tumor testing for p51 levels to see if that therapy had good odds of working, and he said they "Don't do that". It was strange because I had just had tumor testing for my SCC starting Libtayo which works on the same pathway as Keytruda, but he blew it off. Perhaps the difference in having a urologist manage cancer treatment vs an oncologist manage care?

@dks2500 Hi. BCG has been used for 40 years and they call it the gold standard. My first urologist (local) tested me for biomarkers that would cause failure. That test showed only a 40% chance of success. The local urologist said they were still going to start treatment with BCG. I had TURBT recently at Mayo and the surgeon told me that not enough research has been done on biomarkers to validate that testing. Good luck. Hope this info helps you.

@dks2500 I’m being treated at another major medical center, UT Southwestern in Dallas. My doctor has two trials underway asking just that question: how to tell if you will respond. One is using high resolution images of tumors, then following patients for a few years to see if A.I. can predict which will respond and which will not. (To the human eye they all look the same.) The other is using fluid obtained during cystoscopies (sorry - “backwash” for lack of a better term) to ask the same question. My doctor says that right now there is no way to predict, so that’s what he and others are working on.