The Importance of Personalized Treatment Approaches for Urologic Cancers

Personalized strategies are vital for treating urologic cancers, says Dr. Smith, who tailors care based on tumor traits, patient health and quality-of-life goals.

Personalized therapeutic approaches are essential for treating patients with urologic cancers, such as bladder and kidney cancer, according to Dr. Armine Smith, a urologist at Johns Hopkins University in Washington, DC.

She went on to emphasize that these personalized treatment decisions typically involve bladder preservation or partial nephrectomy. These approaches depend on multiple individualized factors that vary with each patient, including tumor characteristics, overall health and functional outcomes. Overall, the goal is to maximize quality of life and long-term organ function, Smith says.

Smith is also the director of urologic oncology at Sibley Memorial Hospital and co-director for women's bladder cancer program at Johns Hopkins University and Greenberg Bladder Cancer Institute.

CURE: For patients newly diagnosed with bladder cancer, especially those considering bladder preservation, what are the key factors you weigh when determining if this approach is suitable, and how do you personalize the treatment plan?

Smith: So, when considering bladder preservation, we'll look at the standard information that comes with it, like bladder tumor grade stage. There are some other additional factors that may make the patient more suitable or not for bladder preservation. [These factors include] if there are multifocal tumors, if there are any advanced stage that's present, if the tumor is unresectable, as well as [the] urological subtypes of these bladder cancers.

Those are all the important pieces of information we consider. To preserve the bladder, we need to have a functioning bladder that will give the patient good quality of life afterwards. Some other factors to consider. This is a pretty complex process. Some of the factors are just patients’ overall morbidities, you know, their health, their ability to adhere to these very stringent surveillance protocols [and] the ability to undergo these treatments.

So currently, the bladder preservation includes treatments with chemotherapy, or immunotherapy with radiation to the bladder, and resections of the bladder and the ability to continue the monitoring. All of this information comes together when we find the right personalized approach to every patient for this.

With advancements in minimally invasive and robotic surgery for kidney cancer, such as partial nephrectomy, what are the potential benefits for patients regarding recovery time and long-term kidney function?

Robotic and minimally invasive kidney surgery has been a game changer because it results in less blood loss for patients, quicker recovery, less pain during recovery, and shorter hospital stays. The robotic approach, building upon the minimally invasive approach, has allowed us to treat more complex tumors because the robotic instruments have an additional degree of motion compared to laparoscopic instruments.

As far as long-term function, partial nephrectomy preserves a significant portion of the kidney, which allows patients to have better kidney function going forward and avoid dialysis. Some studies suggest that better kidney function helps patients with their cardiovascular health, although the definitive link between surgical intervention and this benefit is still being researched.

Nevertheless, we generally aim to preserve kidney function when possible and perform minimally invasive surgery to optimize recovery and minimize pain and scarring.

What factors determine if a patient is a good candidate for partial nephrectomy?

Candidates for partial nephrectomy are usually those with tumors that are not too large, localized to the kidney, and technically resectable. Other considerations that come to mind when deciding if this is the proper treatment for the patient are their overall kidney function and select cases where preserving kidney function is crucial, such as people with a solitary kidney. In these patients, we might attempt kidney preservation even with larger tumors.

Another scenario involves younger individuals who develop kidney tumors and whom we believe might be at risk of developing more tumors in the future; these patients sometimes undergo periodic efforts to perform partial nephrectomies.

What are some of the most common misconceptions you encounter regarding urologic cancers, and what advice would you give to patients seeking reliable information and support resources?

I think what comes to mind when you ask this question is bladder cancer. One misconception is that some people don't realize smoking causes bladder cancer; they think it only causes lung cancer. The other misconception I hear is that bladder cancer is a disease of male smokers. However, it can happen in men and women, young and old. Smoking is one of the known risk factors, but chemical exposures and sometimes a genetic predisposition can also lead to it.

Another misconception is that there's a one-size-fits-all approach to these cancers. Again, talking about bladder cancer, some cases are easily treatable and don't pose a risk to life, while others require ongoing treatments and surveillance and carry the risk of progressing to metastatic disease.

When I talk to patients, I usually provide them with reliable sources of information they can turn to, such as the Bladder Cancer Advocacy Network, the American Urological Association, and many larger institutions, including ours, have web pages that provide more information about these kinds of disease states.

Transcript has been edited for clarity and conciseness.

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