BERKELEY, CA (UroToday.com) - Muscle-invasive bladder and metastatic bladder cancer are disease processes that are daunting to the clinician and scientist.
These diseases are aggressive and formidable. Over the past few years, several characteristic genes have been isolated that can help differentiate aggressive from nonaggressive bladder cancer. Identification of these unique pathways is beginning to shed light on this difficult-to-treat disease. These pathways would hopefully lead to a molecularly targeted approach to this disease.
There are, however, challenges that need to be overcome:
- Several neoadjuvant trials have been done but are underpowered. The studies that had enough patients took many years to complete for muscle-invasive bladder cancer. Metastatic bladder cancer had slow accrual.
- There is poor patient accrual for clinical trials.
- There is a lack of funding for clinical trials of bladder cancer.
- There is poor communication between doctors in different specialties; e.g., the urologist and the oncologist.
- There is a lack of interest among urologists to care for bladder cancer patients because of poor reimbursement and multiple complications from surgical procedures.
These are some of the major hurdles.
Some solutions include:
- patient education and awareness,
- fostering cooperation between physicians in different specialties by developing a multidisciplinary approach in the treatment of these patients,
- mobilizing patients and clinicians to encourage benefactors to fund studies,
- and encouraging molecular biologists to translate these findings into clinically relevant treatments.
Our hope is that bladder cancer can be a treatable and a controllable disease, with multiple treatment options. The options today are too toxic and difficult for patients to tolerate. Less toxic and more tolerable treatments should be developed to improve quality of life.
There is hope when there is a vision.
Winston Tan, MD., FACP., as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.