Over 81,000 new cases of bladder cancer will be diagnosed this year in the United States. While the standard of care for diagnosing and treating bladder cancer has been the same for decades, new innovations may be coming.
Currently, bladder cancer is diagnosed with a procedure called cystoscopy, providing direct visualization with a telescopic lens and scope to evaluate the inside of the bladder. The procedure, which typically involved biopsies, is done under anesthesia.
Diagnosis shows whether the cancer is or isn’t invasive.
“The majority of people have cancer that is not invasive,” says Sam S. Chang M.D., M.B.A., a professor in the department of urology and Patricia and Rodes Hart Professor of Urologic Surgery, and chief surgical officer at the Vanderbilt Ingram Cancer Center. “Many times, it’s not necessarily life threatening.”
Dr. Chang, the assistant secretary of the American Urological Association and chair of the American Board of Urology Examination Committee responsible for board certification in the U.S., shares his insights into new diagnostics and treatments for bladder cancer.
Are there innovations in diagnosing bladder cancer?
We need a test to tell us that we’ve got bladder cancer without requiring an invasive procedure. If we could give a urine sample, analyze it, and determine if there is or is not cancer, , it would be great. We’re not there yet. We’re getting closer and closer.
How is bladder cancer currently treated?
Many times, it’s the endoscopic removal of the bladder tumor but sometimes the entire bladder needs to be removed.
About a quarter of patients who have bladder cancer, have invasive cancer. This stage of cancer is significant and life threatening cancer that requires the majority of times: chemotherapy, surgery, and/or possibly radiation.
many times, we’ll put different types of medicines inside the bladder to prevent tumors from coming back.
We have not had a new medication to put into the bladder to help treat bladder cancer for decades. We’ve put the same type of treatment in the bladder, chemotherapy agents or also very commonly something called BCG, (Bacillus Calmette Guerin), which was really one of the first medicines that was a successful immunotherapy — medications which do not attack the cancer, but actually stimulate our own body’s immune system to attack the cancer.
Multiple decades ago, it was found that when BCG was placed in the bladder that the immune system kicked in and then would attack the cancer cells and would help prevent them from coming back; it has been a very effective treatment. That’s part of the reason why there’s been no further development because the treatment has set a high bar of success.
Does BCG work in most cases?
BCG is effective 60-80% of the time. Tumors that are not effectively treated by BCG are called “BCG-unresponsive cancer.”
Tell us about the BCG shortage.
There’s a single company that makes BCG approved in the U.S. and that company has had at times, difficulty meeting demand, as well as also having issues at times with quality control. As a result, with distribution variances of the medication, increasing demand, and a single company making this medication, shortages have become commonplace.
Can new treatments help prevent bladder removal, which is a goal of the American Urological Association?
Important trials of medications and medical treatments have been reported that do demonstrate a significant response and can really be effective. We’re not there yet, however, of FDA-approved options. But our goal clearly is to treat patients more effectively sooner, so they don’t develop invasive disease. And if they do have invasive disease, develop treatments, hopefully that would obviate the need for bladder removal.
What’s next in treatments?
In the past few years, multiple immunotherapy medications have shown a survival advantage. We have a different category of drugs that target mutations. A third mechanism is antibody driven.
Research continues for medications that are given locally in the bladder, successfully eradicate tumor and prevent its recurrence, and minimize side effects.