Max Kates, M.D., answers common questions about bladder cancer, including who is at risk, signs and symptoms, as well as the latest treatment options at the Johns Hopkins Greenberg Bladder Cancer Institute.
Mhm. Yeah, We are identifying patients with non muscle, invasive bladder cancer that are starting BCG therapy, which is the standard of care. First line therapy for most non muscle invasive bladder cancers. And we're sequencing their tumors before and after therapy and trying to identify what are the genomic predictors of response to BCG. Why is that important? It's really important because we know that around 40% of patients undergoing BCG will not respond. And so we want to identify signatures that will predict which patients will not respond. And those patients maybe should go onto a different therapy, or perhaps even directly onto surgery if they're going to progress rapidly through their BCG. So this is one of the most exciting and I think clinically applicable things we're doing in the lab because there's direct implications for how we would use this genomic signature, this genomic biomarker, uh, at the bedside bladder. Cancer patients are often, uh, older patients with many medical comorbidities and oftentimes, you know, have varied goals of care. And so one of the things that I think is really important about our approach to treating bladder cancer patients is we really spend time at their initial diagnosis, Uh, meeting uh, sitting down with them and their family members and saying, Okay, what's important to you? Um, because And that's really important place to start because we have multiple options, especially for patients, for example, with muscle, invasive bladder cancer or with high risk, non muscle invasive bladder cancer. We can try intra vehicle therapies. We can do chemotherapy with radiation to try to preserve their bladders. If that's what's important to them, Um, and then we can go on to the surgical options, including radical Suspect me when we do radical suspect me, which is removal of the bladder. There are multiple different ways in which we can reconnect the urinary system. And so understanding from the patient's perspective, what's important to you? Is it not having an external appliance or in Ostuni? Is it not getting up at night 34 times a night to to urinate? And so all of these components are factored into that initial, uh, you know, encounter that initial meeting and allow us to sort of set the stage for how we're going to treat them. And it's an evolving conversation. It's ongoing, but that's really what I think is, uh is both unique. And I would say essential about our approach to managing patients with bladder cancer. Yeah, one of the things that I think is essential and important about the way we manage patients with bladder cancer here at the Brady Urological Institute is the multidisciplinary care we offer. So what does that actually mean on a weekly basis? What it means is that I'm I'm oftentimes seeing patients the same day as a medical oncologist. Um, we're coming up with management plans, uh, together oftentimes, Uh, and this is really important because bladder cancer has gone from being a patient from being a disease where the urologist treats the patient, and then they progress. And then you send them to the medical oncologist. To now we have systemic therapies for early stage disease. We do surgery more often for advanced stage disease than we used to. And so it's really essential that often times three or four different subspecialties, uh, including a medical oncologist, a radiation oncologist, sometimes a pathologist or radiologist. All these people are actively involved. Sometimes in a single patient, we meet weekly to discuss patients, and oftentimes we're seeing patients together. I think, overall, the most important thing that I'm proud of is our safety and our competency around how we manage our patients, uh, surgically in the hospital so that that, to me, is is number one. Um, but beyond that, um, I think we're constantly, um, managing the patient and not the disease. So what do I mean by that? Is that we're understanding the patient's goals, priorities and overall health picture, and we're managing their bladder cancer within that, and, uh, that's sometimes challenging. Um, but we're oftentimes talking to their primary care doctors that are referring us to their urologists that are referring us and, uh, embedding them, Uh, you know, within that management plan. Mhm. Yeah.
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