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Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.

The phase 1 study is set to begin later this year. 

FDA greenlights phase 1 trial of theranostic radiopharmaceutical for mCRPC

The approval is supported by data from the pivotal phase 3 ARANOTE trial. 

CHMP recommends EU approval of darolutamide plus ADT in mHSPC

The approval is supported by several studies highlighting the efficacy of Rezūm Water Vapor Therapy in patients with larger prostates,

FDA approves label expansion for Rezūm Water Vapor Thermal Therapy for BPH

The conversation covers practical, case-based strategies for counseling MSM patients.

Pearls & Perspectives: Sexual Health in MSM, with Joshua R. Gonzalez, MD

The bladder cancer section is a comprehensive resource for urology news and expert insights. Read more at Urology Times.

Bladder Cancer | Urology News & Expert Insights | Urology Times

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Clinical Focus

 highlights the state of bladder cancer care in recognition of Bladder Cancer Awareness Month this May. During the discussion he touches on his own clinical practice, recent advances in the field, data on bladder cancer presented at the recent AUA meeting, including his own study, "Mental health illness in patients with non-muscle invasive bladder cancer. Does BCG play a role?", and more. 

Kamat is a professor of urologic oncology at University of Texas MD Anderson Cancer Center in Houston. 

Don’t forget to subscribe to Speaking of Urology® on 

, or anywhere that podcasts are available.

In this episode, Ashish M. Kamat, MD, MBBS, highlights the state of bladder cancer care in recognition of Bladder Cancer Awareness Month. 

Bladder Cancer Awareness Month: Dr. Kamat highlights the state of bladder cancer care

® Assistant Editor Janelle Hart spoke with 

They give an overview of the app they co-created, BlaTUR, which was designed to help clinicians risk stratify their patients and manage their practices more efficiently. Ritch is an associate professor of urology and associate director of UHealth International, and Katz is a PGY5 resident at the Miller School of Medicine, University of Miami, Florida.

“It's not a replacement for clinical judgment, obviously. But at the end of the day, the idea is that it shows you what your next steps are based on what the American Urological Association and [Society of Urologic Oncology] guidelines are for non-muscle invasive bladder cancer,” Chad R. Ritch, MD, MBA, FACS.

Speaking of Urology Podcast: Dr. Ritch and Dr. Katz discuss new bladder cancer management app

He discusses the current state of the BCG shortage, what is being done to resolve it, and what the future holds for patients with non–muscle-invasive bladder cancer who are seeking treatment. Chang is a Patricia and Rodes Hart professor of urology and oncology at the Vanderbilt University Medical Center and chief surgical officer at the Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee.

“I wouldn't be surprised if we have spotty distribution areas of concern for the next several years,” says Sam S. Chang MD, MBA, on the latest episode of the UT podcast Speaking of Urology. 

What does the BCG shortage look like in 2021?

 paper, “A 30-Year Review of Cystectomy Litigation,” for which she served as senior author. The paper, Malik says, “is a snapshot into what we can find about malpractice associated with cystectomy.” Malik is an assistant professor and director of female pelvic medicine and reconstructive surgery at the University of Maryland Medical System, Baltimore.

A search of a legal database found 42 cases related to cystectomy over a 30-year period.

Dr. Rena Malik on cystectomy-related litigation

 discusses findings from a paper published in Urology titled, Comparing Costs of Radical Versus Partial Cystectomy for Patients Diagnosed With Localized Muscle-Invasive Bladder Cancer: Understanding the Value of Surgical Care, for which he served as a study author. Williams is chief of urology and professor of urology and radiology at the University of Texas Medical Branch at Galveston.

Williams discusses a study comparing costs for radical versus partial cystectomy.

Dr. Stephen Williams on costs of surgical treatments for bladder cancer

In this episode, Angela B. Smith, MD, MS, of UNC Lineberger Comprehensive Cancer Center, discusses the recent FDA approval of Jelmyto, which is the first therapy for the treatment of low-grade upper tract urothelial cancer.

Speaking of Urology podcast: Dr. Angela Smith discusses Jelmyto for low-grade UTUC

Anne K. Schuckman, MD, describes the growing number of options in NMIBC and the impact of these therapies on clinical practice.

From BCG shortage to scientific surge: Inside the NMIBC treatment renaissance

The CHAI biomarker was shown to outperform EAU and AUA stratifications. 

CHAI biomarkers demonstrate prognostic utility for high-grade Ta NMIBC

The approval is supported by findings from the phase 3 ENVISION trial.

FDA approves mitomycin intravesical solution for recurrent LG-IR-NMIBC

The objectives of the trial are to further confirm the recommended phase 2 dose and to assess the efficacy of MVR-T3011. 

Phase 2 trial of oncolytic immunotherapy launches in BCG-unresponsive NMIBC

"As urologists, we are the gatekeepers, and we must always perform the best possible surgery to optimize oncological outcomes," writes Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery).

En bloc resection of bladder tumor: Is it the way forward?

There has been an explosion in innovation in the non–muscle invasive bladder cancer (NMIBC) space over the past few years. In an interview with 

, detailed the upcoming advancements that she’s most looking forward to seeing.

In the context of the 3 most recent approvals since 2020 and more coming down the pike, she noted, “I think one of the big challenges right now for NMIBC providers is that that we don't actually know the optimal sequencing for any of these agents.”

As time goes on, she says, we’ll learn more about when and in whom these agents work the best, which will help guide personalized treatment strategies.

Schuckman is an associate professor of urology at the University of Southern California in Los Angeles.

Anne Schuckman, MD, discusses the need for optimal sequencing strategies, upcoming data from the SWOG 1602 trial, and the emerging role of ctDNA.

Anne Schuckman, MD, highlights promising new developments in NMIBC

Schuckman also said she is looking forward to seeing outcomes from the phase 3 SWOG 1602 trial (NCT03091660), which is evaluating the influence of BCG strain differences and T cell priming with intradermal BCG prior to intravesical therapy for patients with BCG-naïve high-risk NMIBC. Final completion of that trial is anticipated for June 2026.

Schuckman also noted the recent emergence of ctDNA, saying, “In [the] tumor marker space, I think we're just on the cutting edge of looking at urine biomarkers and ways that we can better follow our patients, triage our patients, try to limit cystoscopy, or pick up on recurrence earlier. I'm really fascinated by the power of circulating tumor DNA, or ctDNA, in the urine and our ability to use that to guide therapy or initiate therapy in a way that's more time responsive than cystoscopy has been historically.”

1. S1602: Different strains of BCG with or without vaccine in high grade non- muscle invasive bladder cancer. ClinicalTrials.gov. Last updated April 2, 2025. Accessed June 20, 2025. https://clinicaltrials.gov/study/NCT03091660

Videos

Anne Schuckman, MD, on optimal sequencing strategies, the SWOG 1602 trial, and the emerging role of ctDNA.

In a recent interview, Rebecca A. Campbell, MD, a urologic oncology fellow at Cleveland Clinic in Cleveland, Ohio, discussed concrete steps to mitigate gender-based disparities in Altmetric Attention Scores (AAS) and citations within oncology, emphasizing the importance of awareness. She highlighted several strategies outlined in a recent paper to address these issues.

One key approach is to increase the representation of women on editorial boards of journals and as reviewers. This can help decrease cognitive bias and promote research authored by women, especially in prominent journals. Campbell noted that articles cited in high-impact journals often receive greater attention in news media and social platforms, leading to higher AAS. By increasing women's presence in these influential roles, the gap in both AAS and citation could potentially be closed.

Rebecca A. Campbell, MD, a urologic oncology fellow at Cleveland Clinic in Cleveland, Ohio, discussed concrete steps to mitigate gender-based disparities in Altmetric Attention Scores (AAS) and citations within oncology

Strategies to bridge gender disparities in AAS and citations in the oncology literature

Another significant step involves encouraging and promoting women researchers and physicians to lead large clinical trials. These trials tend to garner more media attention but are often led by men. Additionally, funding bodies should be urged to consider AAS and citation data within the context of existing biases when evaluating grant applications.

For health care professionals consuming oncology research, Campbell stressed the importance of being aware of these disparities. Although acknowledging the existence of gender gaps, she cautioned against evaluating the significance of an article based on the gender of its first or last author. The goal is to close the gender gap through systemic changes rather than individual bias in article interpretation.

1. Campbell RA, Helstrom E, Chew L, et al. Gender disparities in citations and Altmetric Attention Score in oncology. 

2025 Apr 10:OP2400767. doi:10.1200/OP-24-00767

One key approach is to increase the representation of women on editorial boards of journals and as reviewers.

Panelists discuss how to approach treatment for a younger (49-year-old) male veteran with bladder cancer, focusing on the rising rates among veterans, challenges with recurrent disease despite BCG therapy, various second- and third-line treatment options, including gemcitabine-docetaxel combination therapy and the importance of thorough monitoring for disease progression.

Video content above is prompted by the following:

Case 3: 49-Year-Old Man With Non–Muscle-Invasive Bladder Cancer

Young-onset bladder cancer considerations

Defined as 50 years or younger based on colorectal literature

Growing concern particularly among veterans (Veterans Affairs has designated bladder cancer as service-related)

Balancing long-term quality of life with aggressive disease management

Management of recurrent disease after BCG

Approach to low-grade vs high-grade recurrences

Importance of continued surveillance imaging, including upper tracts

Treatment sequencing considerations for multiple recurrences

Intravesical gemcitabine/docetaxel therapy

Practical aspects of administration schedule

Maintenance therapy importance for chemotherapy efficacy

Logistical challenges in community practice settings

Third-line therapy options for BCG-unresponsive disease

Available FDA-approved options: nadofaragene firadenovec, oportuzumab monatox (N-803), pembrolizumab

Revisiting radical cystectomy discussion at each recurrence

Importance of thorough evaluation including prostatic urethra and upper tracts

Dr Murray on managing young patients with bladder cancer:

 “I focus more on those percentages of the possibility of progression of disease because the patient has so many more years to live. With a good TURBT and complete resection, I’m going to give BCG just like I would for older patients.”

Panel perspective on low-grade recurrence after BCG:

 The panel agreed that low-grade recurrence after BCG for initial high-grade disease represents a “win” scenario that doesn’t warrant radical cystectomy but requires careful monitoring including cytology and upper tract imaging.

Dr Chang on individualized treatment decisions:

 “It’s a combination of how risk-averse the individual is and how risk-averse the treating physician is. You attempt to individualize and personalize care, get as much information as possible. It is really tough for those in practice that don’t see a lot of bladder cancer patients to navigate the nuances of therapy.”

Dr Schmidt on available treatments for BCG-unresponsive disease:

 “We could switch therapy. If going the intravesical route, we have gemcitabine/docetaxel as our de facto standard. Valrubicin is still used in Europe and Canada. We also have newer approved agents including nadofaragene [firadenovec], N-803, and oportuzumab monatox. Some receive pembrolizumab systemically. Radical cystectomy may still be on the table.”

 “The goal should be no patient with non-invasive disease should die of their cancer.” The panel emphasized thorough evaluation of prostatic urethra and upper tracts at every recurrence to ensure bladder-sparing approaches remain safe.

Video Series

Case 3: A 49-Year-Old Man With Recurrent Non–Muscle-Invasive Bladder Cancer

Panelists discuss how to manage the treatment of a 68-year-old woman with painless intermittent hematuria and positive cytology for high-grade urothelial cancer, addressing gender differences in diagnosis timing, the importance of repeat transurethral resection (TURBT) procedures, BCG therapy options, and considerations for radical cystectomy with pelvic organ preservation when BCG fails.

Case 2: A 68-Year-Old Woman With Non–Muscle-Invasive Bladder Cancer

Case 2: 68-Year-Old Woman With Non–Muscle Invasive Bladder Cancer

Gender differences in bladder cancer diagnosis and management

Panel noted women are often diagnosed later due to symptoms being misattributed to other conditions

When accounting for stage at diagnosis, outcomes do not differ by gender

Treatment approach and assessment do not fundamentally differ based on sex

Management of T1 high-grade bladder cancer with carcinoma in situ

BCG induction and maintenance therapy as standard treatment

Radical cystectomy considerations in women

Pelvic organ-sparing approach discussed for female patients

Preservation of vagina, uterus, and ovaries when oncologically appropriate

Discussion of sexual function consideration regardless of current activity status

Pembrolizumab for BCG-unresponsive disease

FDA approval in 2020 based on KEYNOTE-57 study

41% of patients showed response at 3 months

Limited current use as monotherapy in clinical practice

 “I split treatments into those we continue to put inside your bladder that patients are familiar with, and then pembrolizumab, which is FDA approved but administered as an IV therapy by medical oncologists. I emphasize that urology still owns this disease and patients must continue cystoscopy every 3 months.”

Dr Schmidt on radical cystectomy in women:

 “I most generally will try to preserve the entire pelvic floor, including the vagina, if the tumor allows. I don’t think you need to remove the ovaries or uterus, and that will contribute to improved quality of life after radical cystectomy. Even when patients say they’re not sexually active, I don’t make my decision based on that because people’s life circumstances change.”

 “I’m not going to give this patient more BCG, period. I look for alternatives, trials, different medications especially with repeat high-grade disease. I definitely revisit the role of radical cystectomy.”

 The panel noted minimal current use of pembrolizumab as monotherapy for BCG-unresponsive disease, despite its approval. They acknowledged its historical importance in establishing systemic immune modulation in this space and potential for combination therapy in the future.

 a urologic oncology fellow at Cleveland Clinic in Cleveland, Ohio, discussed the findings of a new study examining gender disparities in citations and Altmetric Attention Scores across oncology subspecialties. The study, published in 

, revealed notable variations in how male- and female-authored papers are cited, depending on the oncology field.

One key finding was that in gynecologic oncology—a subspecialty with a high proportion of female practitioners—male-male authored papers were still cited more frequently than expected, suggesting that gender disparities in citation practices persist even in female-dominated specialties. In addition, women-women authored papers in this field were also undercited, though to a lesser extent than male-male papers were overcited.

Rebecca A. Campbell, MD, discussed the findings of a new study examining gender disparities in citations and Altmetric Attention Scores across oncology subspecialties

Study findings highlight gender gaps in oncology authorship and citation

Campbell emphasized that although gender representation in medicine is shifting, structural and cultural biases continue to influence academic recognition.

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