Treatment for muscle-invasive bladder cancer can be nearly as scary as the disease itself. It has typically included removing the bladder plus additional surgery to create another way to hold and excrete urine, within the body or with an external bag. Many patients with bladder cancer would dearly like an alternative to having their bladders removed—and now there may be one: A new study from Columbia University Medical Center and Memorial Sloan Kettering Cancer Center has pointed to a promising alternative.

WHAT’S CHANGED, WHAT HASN’T

The first steps for treating bladder cancer are removing the tumor in a procedure called transurethral resection of bladder tumor or TURBT, followed by chemotherapy. Often these steps eradicate the cancer, yet the standard practice has been for doctors to suggest having the bladder removed in a separate operation, called radical cystectomy, after testing has been completed on the removed tumors and if the cancer was found to have extended into the muscle layer of the organ.

What the researchers wanted to learn was this: If a patient who had muscle-invasive cancer is cancer-free after TURBT and chemo, is it really necessary to then also remove the bladder? What would be the outcome if patients like this were monitored rather than automatically having their bladders removed?

To find out, researchers studied 148 patients who had had muscle-invasive bladder cancer but who had decided on monitoring (also called surveillance) rather than bladder removal after TURBT and chemo. These patients were followed for five years to see how many experienced a cancer recurrence. The average age of the patients was 62, and 80% were men. Here’s what happened over the five years…

  • The survival rate related to the bladder cancer was 90%.
  • 64% of the patients were still free of bladder cancer after five years.
  • 18% had a recurrence that ultimately required removing their bladders.

The researchers concluded that the high survival rate supports the option of surveillance for patients with no evidence of cancer after TURBT and chemotherapy.

ASKING ABOUT SURVEILLANCE

If you have muscle-invasive bladder cancer and your oncologist suggests radical cystectomy, ask about the option of surveillance. It’s not for everyone, but it might be an option for you if you’re cancer-free after TURBT and chemotherapy. Talk about the risks and benefits of surveillance versus bladder removal. Consider getting a second opinion if your doctor won’t discuss the option or isn’t familiar with it.

This is what a surveillance program is likely to involve:

  • Every two to three months, you will need an overall physical exam, an exam with a bladder scope (cytoscope) and urine testing to look for cancer cells.
  • Every four to six months, you will need a CT scan or other imaging study of your bladder.

After five years, if there are no signs of recurrence, these tests may be reduced to once a year.

Surveillance does require commitment on your part, but if appropriate, it can be a much easier adjustment than life without a bladder.