Dad of 2 Discovers Bladder Cancer After ‘Rose-Colored’ Urine Raises Red Flags—Early Action May Have Saved His Life

Ingram began immunotherapy—a treatment that trains the immune system to attack cancer cells from within. “I’m back at work, and I fit the immunotherapy treatment around my job,” he said. “It varies for everyone, but I don’t find it painful – just a bit tiring afterwards.”

Thankfully, Ingram’s treatment was a success, and he is now in remission. He hopes his story inspires other men not to ignore changes in their bodies.

“If I hadn’t gone to the doctor, it could have been a very different story,” he said. “If you get any blood in your wee, you should definitely see your doctor straight away.”

Understanding Ingram’s Immunotherapy Treatment for Bladder Cancer

Immunotherapy is becoming an essential tool in the fight against bladder cancer, especially since 60–70% of patients with advanced cases aren’t eligible for the most aggressive and effective chemotherapy options.

Because Stuart Ingram’s cancer was caught early, he qualified for immunotherapy, a treatment that stimulates the body’s own immune system to attack cancer cells.

“For those patients, we really didn’t have, until recently, very good and effective treatment options,” says Dr. Arjun Balar, assistant professor of medicine and director of the Genitourinary Cancer Program at NYU Perlmutter Cancer Center, in an interview with SurvivorNet.

One major breakthrough: checkpoint inhibitors, a type of immunotherapy drug often prescribed when patients can’t tolerate chemotherapy drugs like cisplatin. These medications work by targeting checkpoint proteins—PD-1 and PD-L1—found on cancer cells that help them evade immune detection.

Related: Which Bladder Cancer Patients Could Benefit Most From Immunotherapy?

“The immune system is then able to wake up again and target the cancer,” explains Dr. Balar.

These treatments include:

• Atezolizumab (Tecentriq) and avelumab (Bavencio) – target PD-L1
• Nivolumab (Opdivo) and pembrolizumab (Keytruda) – target PD-1

By blocking these proteins, checkpoint inhibitors “reinvigorate the immune system, or unleash the immune system against cancer,” Dr. Balar adds.

Immunotherapy Side Effects

While immunotherapy sidesteps many of chemotherapy’s well-known side effects—like hair loss and nausea—it comes with its own set of risks that patients should be aware of.

“Major cancer centers are experienced at spotting and treating immunotherapy side effects,” says Dr. Jay Shah, associate professor at Stanford University and a cancer surgeon at the Stanford Cancer Center. Still, recognizing and reporting symptoms early is key to managing them effectively.

WATCH: Managing Immunotherapy for Bladder Cancer Treatment

Side effects depend on which part of the body the immune system targets:

• Intestines: diarrhea, belly pain
• Lungs: shortness of breath, cough
• Hormone-producing glands: fatigue, headaches, weight loss, nausea, weakness
• Joints and muscles: pain, weakness
• Skin: rashes, itchy skin, blisters
• Heart: low blood pressure, irregular heartbeat

Some patients may also experience infusion reactions, similar to an allergic response, with symptoms like:

• Fever
• Chills
• Rash
• Itching
• Dizziness
• Wheezing
• Trouble breathing

If severe side effects occur, doctors may pause treatment. One way to manage immune overactivity is with steroids. As Dr. Arjun Balar explains, this approach helps “calm the immune system back down.” He adds, “Then usually the side effects go away within a couple of days.”

Understanding How Bladder Cancer Impacts Patients

Your bladder is a hollow, muscular, balloon-shaped organ that expands as it fills with urine, an essential component of your body’s urinary system.

Bladder cancer begins when the cells lining the inside of the bladder start growing uncontrollably and form tumors. “Smoking is a leading risk factor,” with smokers being three times more likely to develop the disease than non-smokers.

Common symptoms of bladder cancer may include:

• Frequent urination
• Pain or burning during urination
• Flank pain (discomfort in the sides of the lower back)
• A sudden, urgent need to urinate
• Blood in the urine, which may appear pink, red, or cola-colored

Bladder Cancer Treatment

Bladder cancer can be treated in several ways, and doctors consider multiple factors when determining the best approach. The tumor’s location and whether it has spread are key details that help guide your treatment plan.

For many patients, surgery offers the best chance for a cure, with different surgical techniques tailored to where the cancer is located in the bladder.

For those diagnosed with non-muscle invasive bladder cancer, the most common surgical treatment is a procedure called transurethral resection of bladder tumor (TURBT). During TURBT, a surgeon inserts a camera-equipped instrument through the urethra and into the bladder, allowing them to locate and remove visible tumors without making an external incision.

The goal is to eliminate all tumors that can be seen through the camera, and most patients are able to return home the same day. However, in some cases, a longer hospital stay may be necessary depending on how much tissue is removed.

WATCH: Treating Late-Stage Bladder Cancer

If a surgeon and pathologist determine that more tissue needs to be removed following an initial procedure, additional surgery may be scheduled four to six weeks later.

Post-treatment monitoring is essential and varies based on how aggressive the tumor is. Most patients will need regular cystoscopy—an internal scope to examine the bladder and urethra—anywhere from annually to every few months during the first few years. This is typically paired with routine imaging of the urinary tract.

When it comes to surgery, chemotherapy is often recommended before a cystectomy, which involves the full or partial removal of the bladder. Administering chemotherapy ahead of surgery—what’s known as neoadjuvant chemotherapy—has been shown in large trials to improve survival in bladder cancer.

In addition to surgery and chemotherapy, other treatment approaches may include immunotherapy or targeted therapy.

A newer option for patients with metastatic bladder cancer who can’t receive cisplatin-based treatment involves a combination of immunotherapy and chemotherapy: enfortumab vedotin (Padcev) and pembrolizumab (Keytruda). In a recent study, this combination achieved a response in 64.5% of patients, offering hope for a more effective and better-tolerated approach to treatment.

Risk Factors for Bladder Cancer

Smoking is one of the most dangerous contributors to bladder cancer. In fact, the National Institutes of Health reports that roughly half of all bladder cancer cases are caused by smoking.

Why? The toxic chemicals in nicotine and other compounds found in cigarettes remain in the bladder for extended periods before being flushed out through urine—giving them more time to damage bladder tissue.

WATCH: Understanding bladder cancer risk factors.

“The first and foremost thing for a healthy bladder is, don’t smoke,” advises Dr. Arjun Balar. “I think that’s an obvious suggestion for a number of reasons. But if we can eliminate cancer risks that are related to smoking, that’s probably the most important thing you can do.”

Tobacco smoke is a toxic mix—the Centers for Disease Control and Prevention (CDC) says that it contains over 7,000 chemicals, with at least 70 known to cause cancer. While most often linked to lung cancer, smoking is also a major driver of other cancers, including bladder cancer.

Cigarette smoking is responsible for 80–90% of lung cancer deaths, and smokers are 15 to 30 times more likely to develop or die from lung cancer than non-smokers. Even exposure to second-hand smoke significantly increases risk.

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