Understanding Bladder Cancer
- An ongoing clinical trial is suggesting that a certain type of treatment for muscle-invasive bladder cancer—noadjuvant chemoimmunotherapy followed by risk-adapted therapy—offered better rates of metastasis-free survival and helped patients keep their bladders.
- Bladder cancer develops when cells that make up the urinary bladder grow and eventually become tumors. Common symptoms include frequent or painful urination or blood in urine.
- SurvivorNet experts say surgery for bladder cancer often offers the best chance for a cure.
- Depending on the aggressiveness of your tumor, cystoscopy (a procedure to see inside the bladder and urethra) will be required to check the area once a year or as frequently as every few months for the first few years after treatment.
The RETAIN-2 trial is suggesting that patients being treated first with a combination of chemotherapy and immunotherapy for muscle-invasive bladder cancer, followed by a so-called risk-adapted therapy were more likely to have metastasis-free survival (their cancer does not spread) and not need their bladders surgically removed.
Read MoreThe neoadjuvant therapy consisted of a combination of four chemotherapy drugs, ddMVAC and the immunotherapy drug nivolumab. According to the National Cancer Institute, neoadjuvant therapy “is given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy.”
Dr. Pooja Ghatalia, MD, of Fox Chase Cancer Center in Philadelphia, offered insight into the findings during a presentation at the 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California.
“Our goal with RETAIN is to help our patients preserve their bladders, if possible, while effectively treating muscle-invasive bladder cancer. With this second trial, we are finding that adding neoadjuvant immunotherapy may help us better achieve these aims,” Dr. Ghatalia said during her presentation last week, Fox Chase Cancer Center reports.
It’s important to note that the standard form of treatment for muscle-invasive bladder cancer is chemotherapy and then bladder removal surgery (cystectomy), a surgery Bradshaw did not have.
Dr. Ghatalia said, “In the active surveillance patient group, who kept their bladder, we’ve seen less disease recurrence compared to the same group in RETAIN-1. However, these results are exploratory as the purpose of RETAIN-2 was not to make a comparison with RETAIN-1.”
Overall, out of 40% of patients who had their bladders removed, no cancer was found afterward, and Dr. Ghatalia explained further, “This suggests that there is potential value in combining neoadjuvant chemotherapy with ddMVAC and immunotherapy for patients with bladder cancer regardless of whether they undergo active surveillance or cystectomy.”
Authors of the study, which is called “Phase 2 Trial of Risk Enabled Therapy After Neoadjuvant Chemo-Immunotherapy for Muscle-Invasive Bladder Cancer (RETAIN-2),” ultimately found amid the interim trial results, that 77.4% of patients have been metastasis-free after two years and 60% of the active surveillance group have kept their bladders since the start of the study.
The RETAIN-2 trial is working off of of another trial, known as the RETAIN BLADDER phase II clinical trial (RETAIN-1).
Understanding Bladder Cancer & Treatment
Bladder cancer develops when cells that make up the urinary bladder start to grow and eventually develop into tumors. And when these cancerous tumors become muscle invasive, or spread into deeper layers of the bladder wall, the bladder may need to be removed all together along with nearby lymph nodes, other organs in the pelvis and potentially other nearby organs as well.
“For most patients who have invasive bladder cancer, the mainstay of their therapy is surgery, to remove the bladder, and the technical term for removing the bladder is radical cystectomy,” Dr. Jay Shah, the cancer care program leader for urologic oncology at the Stanford Cancer Center, told SurvivorNet.
“And what it entails is removing the bladder, plus all the organs nearby, removing the lymph nodes, which is the first place that bladder cancer can spread out of the body, and then we have to do something called a urinary diversion, which is finding some way for the patient’s urine to get out of their body.”
Bladder cancer is the sixth-most common type of cancer overall in the United States, though it is the fourth-most common for men.
My Bladder Cancer Has Spread. What Are My Options?
When it comes to muscle-invasive bladder cancer, complete removal of the bladder is considered the optimal method to cure. However, for patients who cannot have surgery due to medical problems or personal preference, chemotherapy combined with radiation can be an alternative.
And although radical cystectomy (complete removal of the bladder) is the standard approach for this type of bladder cancer, research shows that adding chemotherapy before you head to the operating room decreases the chance of cancer coming back and increase survival.
Treatment that is administered before surgery is called “neoadjuvant.” Pre-surgery is the ideal time to give treatment, because up to 30% of patients experience post-operative complications that would otherwise delay or entirely prevent safe delivery of chemotherapy. Different combinations and doses of treatments may be recommended based on your age, other medical conditions, and whether the cancer has spread to nearby lymph nodes. The two most common regimens are MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin). These regimens are given for approximately 2-4 months between your diagnosis and surgery date. Imaging tests such as CT scans may be ordered to check your progress with chemotherapy.
Treatment for bladder cancer depends on several factors including the type of tumor, stage of disease and your general health. Your personal wishes, values and expectations also play a role in the treatment plan you and your doctor choose.
How Should My Doctor and I Make a Treatment Plan For Bladder Cancer?
Your doctor is often part of a team that will help you make decisions about treatment options. This may include surgeons, pathologists, medical oncologists, radiation oncologists, urologists and other health professionals. You should feel comfortable asking questions about any aspect of bladder cancer treatment before making a decision.
Terry Bradshaw’s Cancer Journey
Terry Bradshaw previously shared details about his battles with two forms of cancer. He was diagnosed with bladder cancer in November 2021.
Bladder cancer develops when cells that make up the urinary bladder start to grow and eventually develop into tumors. [It’s worth noting that the National Cancer Institute puts it as the sixth most common type of cancer overall in the U.S.]
Dr. Jay Shah, the cancer care program leader for urologic oncology at the Stanford Cancer Center, previously told SurvivorNet, “Bladder cancer is one of those cancers that you don’t hear about too often.”
Bladder cancer, which is highly treatable when found early, can often be detected early because the main first sign of the disease is hematuria, or blood appearing in your urine. This blood can change the urine’s color to orange, pink and, in some extreme cases, dark red.
Bradshaw underwent surgery and other treatment before being declared cancer-free.
During today's show, Terry Bradshaw shared that he has been battling cancer over the past year. As of today, he is cancer free, and he discussed his fight and plan for the future: pic.twitter.com/RSwVxlXC97
— FOX Sports: NFL (@NFLonFOX) October 2, 2022
However, months later, Bradshaw’s doctors discovered a tumor in the left side of his neck as he was undergoing an MRI for neck pain. A biopsy later confirmed it was merkel cell carcinoma, which the National Cancer Institute describes as “a very rare disease in which malignant (cancer) cells form in the skin.”
“Merkel cells are found in the top layer of the skin. These cells are very close to the nerve endings that receive the sensation of touch,” the NCI says.
Merkel cell carcinoma tends to grow fast and spread quickly to other parts of the body. The tumor may be skin-colored or shades of red, blue, or purple and may be painless.
Bradshaw underwent surgery, followed by radiation therapy, to treat the disease. His side effects included swelling in his face from the radiation. The cancer warrior shared a bit of his cancer journey in a Sept. 29, 2022, Facebook Live video.
“This side of my face is partially numb. It’s gonna take a while,” e said in the video post.
A few weeks later, Bradshaw was back on air fulfilling his pre-game hosting duties as an NFL analyst. During the segment, he spoke openly about his cancer journey, explaining, “In November, I was diagnosed with bladder cancer. I went to the Yale University Medical Center for surgery, treatment. As of today, I am bladder cancer-free. Alright, that’s the good news.”
RELATED: Guide To Bladder Cancer
Bradshaw went on to share his skin cancer diagnosis with concerned fans who saw him lose his breath during a television segment a week earlier.
“Folks, I may not look like my old self, but I feel like my old self,” he concluded. “I’m cancer-free, I’m feeling great. And over time, I’m going to be back to where I normally am. So I appreciate your prayers and your concern.”
Questions To Ask Your Doctor After Being Diagnosed With Bladder Cancer
A new bladder cancer diagnosis can feel incredibly overwhelming. That’s why it’s important to prepare for your cancer journey by asking your doctor the right questions.
Knowing what to expect during and after treatment can help relieve stress and make a difficult experience more manageable. It also gives you time to plan and make arrangements for any care you may need.
What Are the Signs and Symptoms of Bladder Cancer?
“I tell all my patients that we’re gonna get to know each other really well,” says Dr. Shah.
“You need to develop a relationship with your urologist because once you have bladder cancer, you need to have someone that’s following you regularly for the rest of your life.”
Asking questions helps you learn more about your healthcare team’s experience treating bladder cancer and begin forming a relationship with them. Your doctor should be happy to answer your questions, so don’t hesitate to speak up.
Consider asking your healthcare team the following questions:
- What type of cancer do I have?
- What stage is the cancer?
- Has the cancer spread to other organs? If so, where?
- What does my prognosis look like?
- Should I see a genetic counselor for testing?
- Should any of my family members be tested?
- Will I have a better chance of success if I travel to a cancer treatment center instead of seeing a local urologist?
- Should I consider getting a second opinion?
Knowledge is power. By speaking with your doctor and finding answers to these questions, you can learn more about your bladder cancer diagnosis and make informed decisions about your treatment options.
Finding Bladder Cancer Support
Support for anyone battling bladder cancer is important during and after cancer treatment. Ask your doctor about community organizations, support groups and other resources to help you connect with others.
RELATED: Guidance for Cancer Caregivers
Consider asking your health team the following questions:
- Are there any resources available specifically for bladder cancer patients?
- Should I speak with other patients who have had the same diagnosis?
- Are there any support groups in my area?
- Are there resources for paying medical bills?
- Who should I contact for more information regarding these resources?
- How do I find out what my insurance will/won’t cover?
Remaining positive throughout your journey, just as Bradshaw did with the help of his wife, Tammy, who he’s been married to since 2014, will help you successfully manage your symptoms and take advantage of opportunities for support.
Get the answers to all of your questions so you can start your bladder cancer journey with the peace of mind that comes from knowing what to expect.
Contributing: SurvivorNet Staff
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