Of 221 patients with superficial bladder cancers treated with intravesical BCG, BCG therapy failed locally within the bladder or prostate in 41 patients. A multivariate analysis was done using data on these local failures to identify clinical variables influencing survival. Patients presenting with T1 tumors which relapsed initially in the prostate were at highest risk of dying of bladder cancer. Cystectomy is justified in such patients. Others with noninvasive local refractory disease can be managed by continued conservative therapy.