Matters of the Bladder: 9 Facts about Bladder Cancer

Bladder_ImageThe bladder is an organ comprised of several layers of cells, and its main job is to store urine. When it’s full, it lets you know. But, chances are there are many other things about the bladder that you may not know. In honor of bladder cancer awareness month in May, here are 9 facts:

  1. There are different types of bladder cancer. Tumors typically form within the different cell layers of the bladder. The name of the specific type of bladder cancer refers to where the cancer started. That’s why bladder cancer is sometimes referred to as urothelial (one of the layers) carcinoma (a fancy word for cancer).
  2. Blood in the urine is a red flag. The most common sign of bladder cancer is blood in the urine (also called hematuria) that can be seen by the naked eye. Usually it is painless. But, bladder cancer isn’t the only culprit for blood in the urine. It can also be caused by an infection or kidney stones. Blood in the urine requires evaluation by a healthcare professional.
  3. It’s common. Bladder cancer is the fifth most commonly diagnosed cancer in the U.S. The National Cancer Institute (NCI) estimates 76,960 new cases of bladder cancer and 16,390 deaths from the disease in 2016.
  4. But lacks funding for research. It is through research that we are able to develop new treatments and ultimately cures. Despite being the fifth most commonly diagnosed cancer in the U.S., bladder cancer ranks 23rd in terms of federal funding.
  5. Some people are at increased risk. Smoking is the greatest risk factor. The good news is you can reduce your risk if you quit. We even have a program to help you get started. Bladder cancer is 3x more common in men than in women, and Caucasians are 2x as likely to develop bladder cancer than African Americans or Hispanics. Risk also increases as you get older and if you have a family history. Visit the Bladder Cancer Advocacy Network to learn more about additional risk factors.
  6. It is diagnosed through different tests. These typically include imaging tests such as ultrasounds, MRIs or CT scans to better see your bladder, urine testing to determine the presence of cancer cells and a biopsy to remove a sample if an area contains cells that appear suspicious.
  7. Treatment will depend on the type of bladder cancer and how advanced and aggressive it is. Treatments vary by stage and include surgery, chemotherapy and immunotherapy.
  8. Immunotherapy offers promise. Immunotherapy is a very encouraging approach for treating bladder cancers and other tumors arising from the renal pelvis and ureters. There are a number of different types currently in clinical trials and the FDA just approved a new treatment called atezolizumab (brand name: Tecentriq). Our team recently presented and published our findings on another form of immunotherapy for bladder cancer, an antibody drug conjugate called IMMU-132.
  9. We are dedicated to and on the forefront of bladder cancer research. At Weill Cornell Medicine, we are committed to research in order to improve outcomes for patients with this disease. The newest member of our Genitourinary Oncology team, Dr. Bishoy Faltas, is dedicated to understanding the genetic makeup of bladder cancer. He’s currently focusing on the genomic changes that happen as the tumors become resistant to chemotherapy. We’re also trying to understand why some patients respond well to immunotherapy, while others do not.

Dying from Prostate Cancer: Lessons Learned from the PLCO Trial

Screening for any disease, including prostate cancer remains imperfect. One study, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, was a National Cancer Institute (NCI) sponsored study that took place between 1993-2001. The goal of the trial was to investigate the impact cancer screening had on dying from these four common tumor types. There were 76,693 men evaluated in the prostate cancer portion of the study.

While some aspects of this randomized trial remain controversial, including the impact that screening had on dying from prostate cancer, it remains a rich prospective dataset for further analysis, as it is one of the largest longitudinal studies ever conducted of men with prostate cancer.

In the “intervention” arm of the PLCO Screening Trial in which men were randomized to be screened for prostate cancer with annual prostate specific antigen (PSA) blood tests and digital prostate exams, there was still an unfortunate set of men who died from prostate cancer. Because the goal of the trial was to determine the prostate cancer mortality differences between the two arms, an understanding of who died and how they died is extremely important.

In a study led by Weill Cornell Medicine’s Dr. Chris Barbieri, we examined how men died of prostate cancer. Dr. Sameer Mittal presented the results of the research at an oral podium presentation yesterday at the 2016 American Urological Association annual meeting, with full results simultaneously published in European Urology.

Of 38,340 men in the screening arm, 151 died of prostate cancer. After graphing their oncologic courses of diagnosis and treatment, we noted a few interesting trends. The most prominent were as follows:

  • More than 50% of the men who died (81 men) either were never screened before this test or had their first PSA test result that was positive. These men were older and had higher median PSA (13.7). It’s possible that if these men were actually screened and or screened earlier and treated, their deaths from prostate cancer could have been prevented.
  • A subgroup of men who died despite screening were young and had a low median PSA (2.0). Surprisingly, they died within approximately 1.5 years of diagnosis. To put this in perspective, we expect an average man diagnosed with metastatic prostate cancer to live for 5 years, so this is quite unusual. We know that some subsets of prostate cancer do not secrete high levels of PSA and this is an area that needs more research in order to prevent further deaths. We don’t know for sure if these men had neuroendocrine prostate cancer (NEPC), but their rapid disease course seems consistent with this aggressive prostate cancer sub-type.

Despite what some may believe, some men do die of prostate cancer. We continue to research why this is the case in order to prevent further death and suffering from this common disease. These study insights underscore the importance of developing diagnostic biomarkers to better detect aggressive prostate cancers and to best predict the way the cancer will respond to various treatments.

Partnering to Detect Prostate Cancer

By Scott Tagawa, M.D.

Prostate cancer comes in many forms. Some tumors, however anxiety producing, are slow-growing tumors and simply require monitoring. And then, there are aggressive tumors that need treatment as soon as possible. Some times these aggressive tumors even spread microscopically prior to surgery or radiation without us knowing. By finding better ways to detect the types of prostate cancers that need to be treated, and as early as possible, we increase our cure rates and the number of people we’re able to treat effectively, while simultaneously minimizing interventions for those who don’t need them.

So where do we begin when it comes to detecting these aggressive tumors? And differentiating them from their less-aggressive counterparts?

Molecular imaging holds many of these answers, particularly for prostate cancer, as it offers a non-invasive way to detect the presence of cancer and distinguish between aggressive and non-aggressive sub-types. At the Weill Cornell Genitourinary (GU) Oncology Program, we’ve had a longstanding expertise in using molecular imaging to better diagnose and treat cancer.

Slide1
(Left) A traditional bone scan only shows one small possible site of metastases in the shoulder region of the bone, compared with the molecular imaging scan of the same patient (right) which indicates many metastases throughout the body.

Through our collaboration across multidisciplinary teams and with industry partners, at our academic medical center we have developed several imaging compounds, such as 99Tc-MIP 1404. This is a radiotracer used to more clearly “see” prostate cancer cells through their expression of the prostate-specific membrane antigen (PSMA). PSMA is a key biomarker in prostate cancer that is present on nearly all tumors. By using this target as a tracer, we can sometimes detect sites of tumors that were not evident on standard types of scans. In addition, the level of PSMA evident in prostate cancer cells can indicate whether the cancer is of a higher grade, more aggressive tumor within the prostate. Our patients were among the first to have received access to this technology. We’re currently leading a clinical trial that is pivotal to the FDA ultimately approving the widespread use of 99Tc-MIP 1404 to detect prostate cancer and help us ultimately determine the best course of treatment.

In part, due to this collaborative work, we were able to recruit the inventor of some of these imaging compounds, Dr. John Babich, to Weill Cornell Medicine in 2013. Collaboration is critical to scientific progress, and we are proud to be building on these accomplishments and forming new strategic partnerships in order to bring scientific discoveries to our patients more quickly than we would be able to if everyone worked in isolation.

It was recently announced that Weill Cornell Medicine has now formed a new research collaboration with Senior Scientific, LLC to investigate using non-radioactive magnetic nanoparticles to detect and diagnose prostate cancer. The combination of molecular nuclear medicine imaging with the magnetic relaxometry (MRX) technology may lead to improvements for many of the thousands of men facing the diagnosis of prostate cancer. We look forward to working with Dr. John Babich to bring MRX technology to our patients and will keep you apprised of research progress.