Hi everyone, I will just lead you through my treatment journey first. I am now 80 and I was diagnosed with bladder cancer in 2016 when my Urologist was taking biopsy of my prostate, he went into the bladder to check things out as I had no symptoms of either bladder cancer or the prostate cancer except in the case of the latter it had increased from 2.8 to 5.4 which was still within the boundaries of normal.
I am fortunate as the initial cancer was non-muscle-invasive cancer. The first step was to clear the bladder and then operate on the prostate. I was treated was with intravesical BCG (24 treatments) then intravesical Mitomycin (12 treatments) all of which was unsuccessful. During all this time I was diagnosed with the most aggressive form of Leukaemia (TP53 mutated, deletion 17p). The prostate was also removed.
My Urologist strongly recommended removal of the bladder as the cancer had changed to Carcinoma in-situ which he advised is very difficult to stop if it escapes the bladder but after discussions with my Haematologist/Onclogist I started a treatment of intravesical Gemcitabine. At last success. I had the initial 6 rounds which had knocked the cancer around but not completely so another 6 rounds with improved success but it was extremely stubborn and difficult to remove, I moved onto a Gemcitabine maintenance protocol with 3 monthly cystoscopy, and if required, TURBT, I had to stop the Gemcitabine after around 4-6 months. Over the next 18 months the treatment started to have an impact with no evidence of cancer since early 2021.
I found that initially I was able to cope with the intravesical Gemcitabine not because of my white blood cell count which reached a peak of 180,000 but my body kept rejecting the Gemcitabine, it was only on a couple of occasions that I was able to hold the drug in the bladder for the required 2 hours, I believe that if this problem didn't occur then I would have enjoyed success much earlier. The problem was created by a combination of an inflamed and irritated bladder caused by the biopsy and the actions of Gemcitabine. The Urologist advised that the surface of the bladder is now smooth and clean so in the event I am forced to undertake more Gemcitabine I believe I will have a better outcome. I am now on 6 monthly cystoscopy and can't wait until this is moved out to 12 months. The other two diseases are responding to treatment, the prostate cancer had unfortunately metastasized into the bones but the treatment is holding it nicely at bay, the leukaemia is also being well managed by the new bunch of drugs that specifically target my leukaemia sub-set.
This has been a bit long winded but I appreciate the difficulty you face in making a decision about Gemcitabine as we are both in the same age bracket and things aren't quite as easy when the clock has ticked over this far. One of the problems we face is the limitation in the choices of treatment of drugs for bladder cancer which haven't advanced like they have for leukaemia and breast cancer but this is something we have to live with. Undergoing treatment is all about providing us with the opportunity to extend our life so if you try the Gemcitabine and it proves to be too difficult for you then you just stop, you will have lost nothing. Best wishes in your decision making and I hope things turn out right for you.

Thanks Colleen,
Actually, I've completed 5 of the 6 scheduled treatments and had side effects after 4 and 5, the 5th noticeably worse than the 4th. Unless I hear something alarming from my doctor, I'll take the last one and hope what side effects there are will end promptly.