After years without any significant treatment advances or new prevention strategies, bladder cancer is finally getting its due.

Recent developments: The FDA approved five new drugs in 2016–2017 for the treatment of metastatic bladder cancer. It’s an important development because these cancers are often deadly, with a five-year survival rate as low as 15% when the cancer is advanced.

Even though the prognosis for people diagnosed with early-stage bladder cancer has been good for quite some time—up to 95% are alive after five years when the cancer is confined to the inner layer of the bladder wall—a late-stage diagnosis now has more treatment options than ever before. In some cases, a new treatment option can double survival time.

What’s more, research is uncovering additional steps that can help prevent bladder cancer from recurring after it’s been treated—strategies that also will help protect people from developing this malignancy in the first place.

PREVENTION IS BEST

Even though bladder cancer does not get as much public attention as certain other types, it is the sixth most common cancer in the US (and the fourth most common among men), with about 81,000 new cases diagnosed every year.

The good news is that most bladder cancers (about 75%) are non-muscle invasive—that is, they’re limited to the lining of the bladder…are usually diagnosed early…and respond well to treatment.

One distinguishing characteristic of bladder cancer is its recurrence rate. More than half of all people treated for this malignancy will have a recurrence. For this reason, it’s crucial for anyone with bladder cancer to do everything possible to prevent a recurrence.

Smokers are four to seven times more likely to develop bladder cancer than nonsmokers. The toxins from cigarette smoke are excreted from the body in the urine—and spend many hours concentrated in the bladder, where they can trigger cancer-causing changes. Other ways to help prevent a bladder cancer diagnosis or recurrence…

• Eat more kale. Cruciferous vegetables (such as kale, broccoli, cauliflower and cabbage) are high in isothiocyanates, chemical compounds that inhibit the ability of cancer cells, including bladder cancer cells, to proliferate. Men who consumed cruciferous vegetables more than five times a week were 51% less likely to develop bladder cancer than those who ate them less than once a week, according to the Health Professionals Follow-Up Study.

Stay hydrated. People who drink more water urinate more frequently, which reduces chemical concentrations and exposure times from cigarette smoke (including secondhand smoke), workplace chemicals (such as polyaromatic hydrocarbons and dyes), air pollution, etc.

Important exception: Research has shown that people who drink water from private wells that may be contaminated with arsenic are at increased risk for bladder cancer. Water that contains high levels of nitrate, a by-product of fertilizers and animal feedlots, has been linked to higher rates of bladder cancer in postmenopausal women. Take note: If you drink well water, get it checked!

CATCH IT EARLY

After prevention, early detection is, of course, the best way to avoid bladder cancer deaths.

An annual urine test may be worthwhile if you’re at high risk—for example, you’re already having symptoms (discussed below)…you are exposed to workplace toxins that increase your risk…you’re a smoker…and/or you have a personal or family history of bladder cancer.

Important: About 80% to 90% of patients who are diagnosed with bladder cancer will have visible traces of blood in the urine. Blood can appear for many reasons, including urinary tract infections (UTIs) or prostate problems. However, if you see blood in your urine, I advise that you assume it might be cancer and see a physician or possibly a urologist.

Other red flags: Frequent trouble urinating…feeling pain or burning while urinating…and feeling that you need to urinate right away, even when the bladder isn’t full. Particularly in women, bladder cancer may be misdiagnosed as a recurrent UTI. A urine culture (not just an in-office urinalysis) is needed to diagnose UTI correctly.

DRUG BREAKTHROUGHS

The recently FDA-approved checkpoint inhibitors target proteins that weaken the immune system. In doing so, the drugs—pembrolizumab (Keytruda), avelumab (Bavencio), durvalumab (Imfinzi), nivolumab (Opdivo) and atezolizumab (Tecentriq)—intensify immune activity against tumor cells.

An older form of immunotherapy, called intravesical therapy, uses a bacterium (BCG) that’s instilled into the bladder. This approach inhibits cancer progression and can reduce the risk for recurrences by about 40%. BCG causes an inflammatory reaction that leads to the recruitment of other immune cells to the bladder, which helps eradicate bladder tumors and helps prevent them from recurring.

Depending on the stage of the cancer, checkpoint inhibitors are an important advancement because they can help patients who didn’t do well with BCG or other treatments—or who improved initially but later suffered a cancer recurrence.

The drugs aren’t a cure, but they can double the survival time in some cases of metastatic cancer that has not responded to chemotherapy. This means the average survival time of six months is increased to 10 to 12 months.

Another potential benefit: It’s hoped that checkpoint inhibitors will control cancer well enough that removal of the bladder, which has been required in those who haven’t responded well to other treatments, can be delayed or avoided altogether—but this is still being studied.

Downside: Immunotherapy drugs can increase levels of inflammation throughout the body. Many of these inflammatory reactions are minor and can be managed with topical creams or by stopping the drug temporarily for a couple of weeks. However, in some cases, the reactions can be severe and, in very rare cases, even fatal. When the reaction is more severe, the drug is stopped and the overactive immune system is suppressed by giving steroids and other immunosuppressive drugs.