Study Concludes That Cystoscopy Has Major Limitations in Predicting Bladder Cancer

 Matthew Zibelman, MD, assistant professor in the Department of Hematology/Oncology at Fox Chase Cancer Center, leads the multi-center trial of the combination of Axitinib and the PD-1 inhibitor Nivolumab. He will present the safety and early efficacy data for the phase I cohort as part of the ASCO 2019 annual meeting.
Matthew Zibelman, MD, first author on the study and assistant professor in the Department of Hematology/Oncology at Fox Chase Cancer Center.

PHILADELPHIA (May 14, 2021)—In a recent study, researchers at Fox Chase Cancer Center found that there are major limitations in using cystoscopy for predicting the presence of muscle-invasive bladder cancer in patients who are candidates for bladder removal.

A cystoscopy is an endoscopic procedure that allows surgeons to examine the lining of the bladder to monitor, treat, or diagnose different conditions.

“The idea of this study was if we took all of these patients and, in a standardized way, looked into their bladder with surgeons who have a lot of expertise, we thought we could show that we can predict quite well who has disease left inside the bladder and who doesn’t,” said Matthew R. Zibelman, MD, first author on the study and an assistant professor in the Department of Hematology/Oncology at Fox Chase.

This is important since some 30% of bladders that are currently removed do not harbor residual cancer after administration of chemotherapy. The study showed that 25% of people who appeared to have completely clean bladders through cystoscopy actually harbored muscle-invasive disease that could be observed when the bladder was removed.

“There were reports over the years stating that you could miss tumors through endoscopic assessment. Yet, the issue was never approached systematically and tackled in a standardized way,” said Alexander Kutikov, MD, FACS, chief of the Division of Urology and Urologic Oncology, who was the primary investigator for the trial.

In the study, 61 bladder cancer patients underwent endoscopic assessment before receiving curative bladder removal surgery. The results of the evaluation were compared with pathology after bladder removal.

“There are submucosal tumors that are latent in the bladder walls that you can’t see from the inside. It’s like looking in a room and there’s something behind the wallpaper,” said Kutikov.

“This is a novel finding that was surprising. I anticipated that the retrospective literature was overestimating the risk. But there is a risk, and this helps us design further clinical trials and helps us find research directions to overcome this barrier,” he added.

The authors noted that future efforts should be aimed at developing new imaging and biomarker methods to improve evaluations before the bladder is removed. Developing more effective strategies in these areas could lead to better decision-making and could help patients forego unnecessary bladder removal surgeries, they wrote.

The study, “Cystoscopy and Systematic Bladder Tissue Sampling in Predicting pT0 Bladder Cancer: A Prospective Trial,” was published in The Journal of Urology.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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