Muscle Invasive Bladder Cancer

I'm glad he's doing so well! It sounds like you're taking terrific care of him!

Hello @grannykaka. Welcome to Mayo Connect bladder cancer. Having muscle invasive aggressive urothelial cell carcinoma is a higher risk of recurrence and metastasis. My husband had this diagnosis 5 years ago. He had surgery to remove the mass because it was in a pouch off the side of the bladder, so that pouch and many lymph nodes were removed (a partial cystectomy). He then had chemo and then BCG but new areas in his bladder kept recurring. After a couple years of this pattern with subsequent TURBTS to remove or cauterize the spots, and a trial on Keytruda, an immunotherapy approved for bladder cancer, tumors kept recurring. He had his bladder removed and a neobladder formed instead of an ostomy. Bladder cancer likes to return and I would be asking your medical team about Keytruda or other treatments. If necessary look into a referral for a second opinion, preferably at a large cancer center or referral hospital. Do you have a large cancer center nearby?

@grannykakIa, I echo @sepdvm's suggestion about getting a second opinion. BCG is primarily used for high-risk non-muscle-invasive bladder cancer (NMIBC) to prevent recurrence and progression and is not typically recommended for bladder cancer that has invaded the mucsle.

Do you have muscle-invasive bladder cancer (MIBC)? Or did I read that wrong?

During my RC, they found cancer in 1 of the lymph nodes of the 24 removed.

@hmmm Hi Tanya , my husband didn’t get the Pathology report yet. We go see the surgeon tomorrow. He wants to get the JP Drain out…hopefully that can happen. The Surgeon said he took out all the lymph nodes. Are you doing immunotherapy once a month?

@jowilliams1 Thank you, Jo :-))))

Yes once a month

Nivolumab (opdivo) is the standard for adjuvant treatment after positive node pathology after RC surgery. In my case I had adjuvant DDMVAC first (as I was upstaged after surgery I was never a neoadjuvant DDMVAC or CG candidate). Typically, it is coupled with signatera ctdna monitoring. In my case Northstar Response ctdna monitoring was also added. Signatera is tumor informed (TURBT and/or RC tissue based). Northstar Response is agnostic methylation based (blood/plasma only: no tissue). Interestingly, Northstar Response has a new more sensitive assay that now explicitly excludes using it for MRD and recurrence monitoring.

If you are going to receive nivolumab there are some boosters: claritin/zyrtec according to MD Anderson, CBM-588 according to many studies, camu camu (castaligin) according to some studies, akkermansia according to many studies. After neoadjuvant or adjuvant chemotherapy and/or antibiotics for related infections, the gut is severely depleted of beneficial bacteria. This hampers the efficacy of nivolumab (and other similar immunotherapies such as durvalumab, avelumab, pembrolizumab and atezolizumab although durva and atezo are rarely used anymore for MIBC).