NMIBC: The TURBT Treadmill

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This segment addresses the frustrating cycle of repeated TURBTs that many patients with non-muscle invasive bladder cancer experience, aptly termed the TURBT treadmill. The panel discusses a 68-year-old female smoker with recurrent low-grade bladder cancer who, despite initial treatment with intravesical chemotherapy, developed multiple recurrences requiring repeated surgical interventions. The discussion emphasizes how recurrent disease creates a predictable pattern of continued recurrences, leading to increased health care costs, patient morbidity, and quality-of-life issues. The panelists stress the importance of recognizing when patients have declared themselves as having recurrent phenotype disease.

The experts explore important sex-specific considerations in bladder cancer management, noting that while bladder cancer is less common in women, they represent approximately 25% of cases and 30% of bladder cancer deaths. Female patients often face diagnostic delays due to symptoms being attributed to urinary tract infections, and anatomical differences present unique surgical challenges. The panel discusses how older women typically have thinner bladder walls, making TURBT procedures more technically challenging and potentially increasing perforation risks. These factors make alternative treatment approaches such as chemoablation particularly attractive for female patients with recurrent disease.

The segment emphasizes the paradigm shift toward treatment de-escalation using UGN-102 as an alternative to repeated surgical procedures. The panel discusses how the 80% complete response rate observed in the ENVISION (NCT05243550) trial, combined with the drug's favorable safety profile and extended dwell time, offer patients and physicians a viable alternative to the traditional surgical approach. This strategy aims to reduce the frequency of cystoscopic surveillance, decrease operative risks, and improve patient quality of life while maintaining oncologic efficacy. The discussion highlights the importance of shared decision-making and early patient education about treatment alternatives.