Case Presentation: Treating Patients With Bladder/Urothelial Cancer Case Presentation

 A 73-year-old male patient was presented with hematuria. Bladder cancer usually is presented with blood in the urine—hematuria is one of the most common, but not the only symptomatology that a patient can appear with. Further workup with cystoscopy and cancer with a bladder tumor section reveals a bladder tumor that was invading the muscularis propria. The muscle wall of the bladder immediately makes what is called muscle visibility cancer.

A staging scan, CT of the chest, abdomen, and pelvis, ideally with intravenous contrast, was performed, in order to have good delineation of the anatomy and staging. Results did not show any further extension of disease and there was no lymphadenopathy or distant metastasis.

The kidney function was normal, and no other major comorbidities, such as hearing loss, major neuropathy, and cardiac failure. The patient had a very good performance status of 0—very functional. This particular patient was offered the clinical trial. Clinical trials are something that we should always keep in mind and offer to our patients in different settings as applicable. This particular patient did not go through a clinical trial at the time. He opted for neoadjuvant cisplatin-based chemotherapy. He received embARC, and accelerated embARC, with growth factors support for 4 cycles. This particular patient tolerated chemotherapy relatively well. There were a series of expected mild to moderate adverse events, which is expected with this chemotherapy, but nothing out of the ordinary.

Following all 4 cycles of neoadjuvant chemotherapy, the patient received a CAT scan of the chest, abdomen, and pelvis. The CAT scan saw some reduction in the tumor size of the bladder tumor, and there were no findings of lymphadenopathy or metastases. This patient, subsequently about 5 weeks after the end of chemotherapy, underwent radical prostatectomy with pelvic lymph node dissection and, despite the reduction in tumor size in CTs basis, and still had pT2 and 0.

 This patient was seen in the clinic by a neurologist and medical oncologist afterwards to discuss options. He had a good recovery after the surgery. At that point, we discussed the potential risk of recurrence, despite the neoadjuvant chemotherapy. We discuss the options of clinical trials, specifically adjuvant trials, that were open at the time.