Episode # 3 • 17 Jan 2025
Understanding Intermediate-Risk Bladder Cancer
By one estimate, half or more of all non-muscle invasive bladder cancer (NMIBC) is intermediate risk, yet the major guidelines still do not define it the same way, which leaves urologists sorting a large, mixed group of patients without a shared playbook for when to resect again, treat in the office, or start intravesical therapy. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Wesley Yip, urologic oncologist at City of Hope, to rethink what she calls the forgotten stepchild of bladder cancer: intermediate-risk non-muscle invasive bladder cancer (NMIBC). Dr. Yip explains why he sees the category as a catch-all rather than a single biological entity, by his estimate covering 50 to 60 percent of NMIBC, why he now relies on the International Bladder Cancer Group (IBCG) definition, and why tumor grade comes first, ahead of multiplicity, size, and recurrence timing.
Timestamps
00:00 - Introduction
02:24 - Defining Intermediate-Risk NMIBC
07:53 - Case Presentation and the Initial TURBT
10:42 - Evaluating the First Recurrence
13:09 - High-Grade Cytology and Blue Light Cystoscopy
15:01 - The Burden of Repeat TURBT
16:57 - Office Fulguration and Chemoablation
20:23 - Chemoablation Tolerability and Patient Selection
24:24 - Intravesical Chemotherapy and Treatment Barriers
28:08 - New Formulations and Upcoming Trials
33:12 - Recurrence After Chemoablation and De-escalation
38:00 - Future Directions and Patient-Centered Endpoints
42:39 - Closing Remarks
Resources
You may also like
More about this episode
Working through the case of a healthy 67-year-old man with recurrent low-grade Ta disease, the two discuss what to document at the first resection, how to counsel patients, when to return to the operating room, and when office fulguration, intravesical chemoablation, or intravesical chemotherapy with gemcitabine and docetaxel makes more sense. They cover the cumulative burden of repeat transurethral resection, practical lessons from bringing chemoablation into the clinic, how to read new trial data, and when to de-escalate surveillance. Dr. Yip closes with his hopes for the next five years: a biology-based definition and trials that measure fewer recurrences, fewer procedures, and better quality of life.
The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.