Step-by-step approach may reduce need to remove bladder in patients with advanced bladder cancer

(SACRAMENTO, Calif.) — Standard treatment for advanced bladder cancer is surgery to remove the bladder, the lymph nodes and surrounding cancerous tissue — a complicated and life-altering surgery known as a radical cystectomy. Yet mounting evidence shows that this approach may be no more effective than a regimen of careful observation and chemotherapy, according to a urologic oncologist from the UC Davis Cancer Center.

Ralph deVere White, director of the UC Davis Cancer Center and chair of Urology Department of the UC Davis Medical Center, believes using a sequential approach that carefully monitors patients after initial surgery could reduce the need for bladder removal by as much as 50 percent.

DeVere White will present his findings at the annual Update in Urology conference taking place at the University of South Florida in Tampa April 12-15, where he is delivering a state-of-the-art lecture on bladder cancer. "What I’m proposing is not a bladder-sparring protocol. Rather, it is meant to be a sequential approach that keeps cystectomies to a minimum without compromising patient survival," said deVere White.

"Obviously, removing a patient’s bladder poses quality of life issues, " he added. " If we can get the same results for patients without cystectomy, it’s worth looking into."

An added benefit of this approach is that it would yield more tissue samples for molecular research aimed at finding new treatments for the serious disease, he said DeVere White’s suggested protocol for newly-evaluated patients with invasive bladder cancer calls for a transurethral resection surgery to remove the bladder tumor, followed by additional surgeries to monitor cancer cell growth. A transurethral resection is a lessor-invasive surgery using a special instrument with a small wire loop that cuts or burns away cancerous tissue.

Subsequent steps would depend on whether tissue samples test negative or positive for additional cancer. Adjuvant chemotherapy is suggested to further improve chances of survival. Cystectomy would remain an alternative.

DeVere White bases his observations on new research from investigators at Memorial Sloan-Kettering Cancer Center and other institutions that indicate transurethral resection with adjuvant therapy gets the same results as removing the bladder.

"Based on these figures we can save about half of the patients with invasive bladder cancer from a cystectomy and give them the same 10-year survival," deVere White said.

The approach has been offered to patients at the UC Davis Cancer Center for many years. A clinical study of cystectomy versus chemotherapy is expected to start at the cancer center in the fall.

Earlier this year deVere White presented his findings at the 48th annual James C. Kimbrough Urological Seminar in San Diego. He will be moderating a plenary session on chemotherapy versus cystectomy for bladder cancer at the annual meeting of the American Urological Association in June.

Bladder cancer is the sixth most common cancer in the United States, claiming an estimated 12,000 lives annually. Risk factors include smoking and exposure to workplace carcinogens. The most common symptom is blood in the urine.

Copies of all news releases from UC Davis Health System are available on the Web at http://news.ucdmc.ucdavis.edu.