Episode # 323 • 11 Aug 2026
Managing Intermediate-Risk Bladder Cancer
How can we best manage intermediate-risk bladder cancer to balance disease control, quality of life, and the growing range of treatment options? On this episode of the BackTable Urology Podcast, Dr. Ruchika Talwar interviews Dr. Charles “Chaz” Peyton about the challenges of treating recurrent low-grade, intermediate-risk non–muscle invasive bladder cancer. They highlight the high recurrence but low progression risk, the often-underappreciated impact of repeated TURBTs on patient well-being, and the evolving landscape of office-based and chemoablative therapies.
Timestamps
00:00 - Introduction
05:58 - Comparing Office Ablation and OR TURBT
08:26 - TURBT Impact on Quality of Life
11:37 - Uncovering Hidden Patient Burdens and Costs
14:44 - Integrating Chemoablation into Practice
18:20 - ENVISION QoL Study Setup
22:04 - Comparing TURBT Preferences
27:40 - Counseling Risk-Averse Patients
29:10 - Community Adoption Advice
31:59 - Upcoming Clinical Trials
35:28 - Biomarkers and Expanding Access
36:23 - Final Thoughts and Closing Remarks
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More about this episode
The conversation covers practical strategies like office-based surveillance and fulguration for small recurrences, identifying triggers for returning to the OR, and recognizing the hidden burdens of TURBT complications such as hematuria, incontinence, and unplanned ER visits. Dr. Peyton reviews the role of chemoablative options for selected patients, discusses trial data on patient-reported outcomes, and addresses the mixed evidence, high costs, and need for individualized decision-making. The episode also explores new intravesical and FGFR-targeted therapies, underscores the importance of cost-conscious adoption and biomarkers, and considers how management approaches must evolve, especially in community practice settings.
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