CredentialsPositions
Board Certifications
Education and Training
- Clinical Associate Professor, Department of Urology at NYU Grossman Long Island School of Medicine
- Director, Urologic Oncology, NYU Langone Hospital - Long Island
Board Certifications
- American Board of Urology - Urology, 2015
Education and Training
- Fellowship, Fox Chase Cancer Center, Urologic Oncology, 2013
- Residency, University of Pittsburgh Medical Center, 2011
- Residency, University of Pittsburgh Medical Center, 2007
- MD from State University Of New York, 2005
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Transcript
Episode Transcript
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(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven to ten WOOR. It'sthe Chairman of Urology at NYU Land Gone
Hospital, Long Island. Here isdoctor Aaron Katz. Good morning everyone,
and welcome again to Kats's Corner hereon wr iHeartRadio. So glad you could
(00:42):
join us this morning. We havea wonderful guest who has been here on
the show before, who will betalking about an interesting topic, one that
we've discussed maybe a couple of yearsago, but there certainly has been some
rapidly new advances in the treatment andthat is of bladder cancer. And we'll
be talking with doctor Anthony Culchrin,who is the director of Urologic Oncology here
(01:04):
at the NYU Land Going Health Centeron Long Island. And Associate Professor of
urology, and he's been in thedepartment for I guess close to I don't
know, maybe ten years or so, and has really done some extraordinary work
in the field of bladder cancer diagnostics, therapy. And we'll also talk to
(01:26):
us about some new clinical trials thatwe have here in the medical center and
some really new advances that have justcome out in the last few months,
actually in the last few weeks,so really exciting stuff. Good morning,
Anthony, thanks for joining us hereon Kancers Corner. Good morning, thank
you for having me. So let'sget right into it. I guess for
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the listeners out there, I mean, how common is bladder cancer? I
mean, we certainly hear a lotabout breast cancer and prostate cancer and men,
but you know, bladder cancer obviouslyaffecting both men and women. Common
is it now? It's fairly common. It's the sixth most common cancer that's
solid organ in you know, menand women. A little bit more common
(02:09):
in men, but it's you know, in the top ten in both sexes.
So you have to be on thelookout, and you know, we
we do see that there are certainrisk factors that people should be aware and
certain symptoms that would indicate a possiblebladder cancer. Typically that's blood in the
urine as the main sign that theremay be something going on, and certainly
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if you have that, you needto seek medical attention. And smoking would
be the number one risk factor inboth men and women. So a history
of smoking. Many people think ifthey quit, there there without you know,
risk that risk anymore, But that'snot true. It is even if
a history of smoking, and thencertainly if you're an active smoker, both
(02:53):
of those place you at elevated riskand if you have bladder cancer. Besides,
I guess you mentioned the most commonsymptom is blood in the urine.
Are any other warning signs that peopleshould know about? Yeah? Almost always
that's what we see. But you'reright, it's not uncommon that there's no
blood in the urine and then wehave other symptoms that might pop up.
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And the problem with that is alot of people owens, aren't thinking about
bladder cancer when it's not the mainpresenting symptom of blood in the urin.
So the ones to also be awareof are changes in urinary habits like say
frequency of urination, urgency of urination. Maybe you have to run to the
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bathroom where you leak because you can'tget there in time. And this is
something that's new and different from whatyou've had before. Obviously, as men
get older, they do experience prostategrowth and that can cause weaker stream and
the symptoms I mentioned as well,but we have to also consider that it
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might not be that, and thereforeseeing in your ogist and getting evaluations both
for prostate obstruction if it's a malepatient, and also things like bladder cancer
are indicated, so we check,you know, certain tests to look and
see if bladder cancer is also present. Yeah, I mean, I'm sure
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it can be confusing, and that'swhy thankfully we have experts like you to
figure these things out. Because people, so you're saying they could have blood
in the urine, but not necessarily, they could have urinary symptoms that are
change in urinate symptoms without blood inthe urine, and then that you throw
in the smoking. I mean,smoking is very common, but I guess
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you don't have to be a smoker, right, and you could have those
symptoms without even smoking and have bladdercancer. Correct. I mean, you
know, we all live in anindustrialized society unfortunately, and smoking isn't the
only pollutant, you know, There'sa lot of different things that we're exposed
to, you know, pollutants inthe air, pollutans in the groundwater maybe,
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And I know that that certain partsof Long Island have higher risks of
that than others, So we haveto be aware of those nuances too.
Yeah, and you've mentioned environmental youknow, toxins. I think we've seen
a number of people here at theyou know, the medical Center, that
we're exposed down at the World TradeCenter, and I think isn't that one
of the potential risks of if youwere down there working on the pile at
(05:21):
the World Trade Center to get youknow, urinary cancers? Is that still
true? Certainly we see prostate alot of men with prostate cancer, kidney
cancer, and yes, bladder canceras well. And it's hard to link
a definite cause and result, butthere certainly is an association with that exposure.
(05:42):
Yeah. And I have to askyou because you know, so many
innovations have come out with testing andis there any you know, this may
sound silly, but are there anyhome tests? Can people just go and
check at home, go to thepharmacy, like like you get a COVID
test or something like that, ordiet test. There are blood pressure obviously
you can do it at home,and then you can do it home or
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no, you have to go tosee the doctor for this, Well,
you should see the doctor. Certainly. There are no tests at home that
would give you a definite yes orno like a COVID test would. But
there are some tests that one couldget from, you know, over the
counter, so to speak, thatlook for blood in the urine on a
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kind of yes no answer. Now, if there's no blood in the urine,
that doesn't mean that there's no bladdercancer. That's just looking for that,
and there can be false negatives andfalse positives. So doing the test
at home can sometimes be helpful forvarious reasons. But I think in this
particular case, certainly, if yousee blood in the urine or if you
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have these changes, it's more nuanced, more you know, little things that
you have to sort through, andI think going to see a medical professional
obviously makes most sense. Yeah,and you got to go through the test,
right, And you could go throughthe test and of course you're going
to be angry, you know,you maybe do have blood in the urine.
Maybe you do have urinoise symptoms,but that's not one hundred percent right
what you're saying, right, Andit's not one hundred percent that you have
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bladder cancer. But you've got togo through the testing, and that's what
we're going to talk about. Socertainly, you know there's a urine tests,
and there's image tests, and thenthere's some tests that need to require
a telescope to look into the bladder. Maybe you can tell us just briefly
about those things and has there beenany changes in those over the over the
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last year or so. Yeah,we always get imaging because we want to
see, you know, what's goingon up in the kidneys as well as
the bladder. Imaging doesn't really lookwell at the inside of the bladder.
It kind of looks more broadly.Sometimes we don't need to do any other
tests besides the cat scan and you'rein testing. But you're right. Ultimately,
the telescope, the cystoscope looking insidethe bladder with the camera is the
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gold standard to evaluate the bladder becausewe can miss small things in the bladder
if we don't look inside, justlike a colonoscopy to look at the lining
of a colon if you want todo it right. So I always recommend
we look inside if there's these symptoms, and that can lead to the diagnosis
of bladder cancer and many patients whootherwise may not have found it. There's
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really nothing to replace that yet.Yeah, yeah, you're right. So
we have some urine tests and we'llget a cat skin and look inside and
then just by your eye and yourexperience, you think you know you're good
enough. At this time, you'vedone I don't know, tens of thousands
of scopes estoscopies. You can tellthat somebody has a bladder cancer just by
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looking at it. Most commonly,yes, almost always, but sometimes there
are cases where we still want todo a biopsy for precautionary reasons. But
in the majority of cases, immediatelywe can tell if there is a cancer
or out and know that going tothe procedure suite, no cuts on the
skin, looking inside with a littlebigger camera when you're asleep. Of course,
(08:54):
to scrape the tumor out is thenext best step. Yeah, and
that can be done, and that'snot a hospitalization usually that's more of like
an outpatient type of a biopsy.Is that that typical correct in and out
the same day. We leave alittle medicine in the bladder that helps to
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kill any free floating cancer cells.If they're there with no additional side effects,
and it's a pretty quick procedure andpretty quick recovery, then we have
a good sense of what's going on. Is it a high grade bladder cancer,
is it a low grade bladder cancer. There's differences between the two.
Low grade doesn't tend to be aninvasive tumor, whereas high grade has that
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potential. So when we see thehigh grades, we have to make sure
we scrape deep into the bladder,into the muscle, air check the muscle,
make sure there's no involvement, becausethe muscle becomes the potential gateway for
spread to other parts of your body. So that's kind of a major difference
in bladder cancer. Is it yes, muscle invasive bladder cancer or no,
what we call non muscle invasive bladdercancer. And you know, just for
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the listeners out there, when youdo these biopsies, and you you know,
you're said you're scraping out or you'reremoving the tumor, but you're more
removing some additional part of the ordeeper part of the bladder muscle to make
sure it's not gone in there.Does that in any way have any negative
effect on somebody's bladder functioning? Isthat? Or does it just heal over
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and and people are fine? Thebladders are very forgiving organ Uh. In
urology we always say I wish mywife was as forgiving as the bladder.
I'd heard that it typically heals upvery nicely. Okay, So so you
can remove that tumor take what's underneathit, and then we call it,
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we stage it, I guess,and check it, make sure it's gotten
into the bladder and then and thenit's forgiving. Uh, And it's and
then people can can move on.And do they have to have any tube
in the bladder like a catheter afterthat or or typically typically not? Okay,
tubeless? Okay, that's always nice. Yeah, we say life with
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a bag is a drag. Soif you don't have to have a bag,
great, So that's fine. Soyou're putting some medicine and you're putting
a chemotherapy in the bladder. Isthat is that right? Is that?
Is that a new drug that you'reusing or is that the same drug?
It's been around for a very longtime, and it turns out it's very
useful in preventing recurrence. It's calledgem cido being it's just a chemotherapy that
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stays in the bladder. There's noadditional effects. Okay, Now, one
other thing I forgot to ask you. Though we talked about smoking is a
risk and environmental what about family history? Does this run in families? Do
you see? I mean, becauseyou see so many patients with bladder cancer,
I mean, yeah, yeah,it's not a common event for this
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to be a familial, inheritable,generational type cancer. Some you know,
that can be like kidney cancer,which retreat, but it can be that
there are certain syndromes within families,namely Lynch syndrome, which has a tendency
for bladder cancer. So certainly ifthere's a history of Lynch syndrome or typically
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recurrent colon cancer is what happens isthe main one. Bladder cancer is also
associated with that syndrome. Mm hmmokay, all right, so typically it's
not in family, So that's okay. So we covered all of the potential
risk factors there. You think forbladder cancer, smoking clearly being the one,
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but even if you smoked, likeyou said years ago, and not
to bring up a point again,but you said if you smoke thirty years
you're still at risk. Is thatwhat I heard? That's correct? Yeah?
Wow, there's nothing anything you cando to reduce that risk. I
mean, obviously stop smoking, butsince you've stopped smoking and you're an ex
smoker, anything that or is abody just already feeling the effects of that
(12:56):
nicotine over the years, and there'snothing. Yeah, I think the molecular
changes that have occurred because of exposureto the toxins have occurred, and then
you know, eventually they may bearthemselves out to be a cancer. And
that's probably true for smokers who allright risk for lung cancer, kidney cancer,
bladder cancer, you know, allthe very prostate cancer, all the
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various different cancers that puts them atrisk for. Yeah. Absolutely overall.
I mean we're going to get intothe different chats, but overall, when
you're faced, you know, witha patient that has bladder cancer, and
I know this is you know,putting on the spot a little bit,
but are you hopeful if you feelthat most of these cancers are you know
that we're treating here at n YUthat you're going to cure them. We
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have so many patients with bladder cancerand you know, of course that that
brings the fear of cancer and thetreatment effects on quality of life. But
really the overwhelming majority of patients,you know, we can manage it,
control it. It is a cancerthat tends to occur, but with the
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treatments, we have a lot ofdifferent options. So there's not only the
first line option, there's the secondline option and so forth. So in
the majority of patients we can youknow, keep you with a good quality
of life, with your bladder intactand you know, cancer free. But
unfortunately, obviously that that's not foreveryone. I can imagine. But is
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it like any other cancer that ifyou get it early, is it more
likely going to be curable? Then, you know, is a good chance
of curing it, even though itcould so it could come back. It
could come back in the bladder,but hopefully it's not going to spread anywhere
else than the rest of the body. Is that correct? And the treatments
that we have to reduce the chanceof recurrence, namely BCG, which is
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putting this tuberculosis medicine in the bladderit's a form of tuberculosis. It actually
is immunotherapy. It tells your ownbody believe it or not to attack the
cancer cells. And it's been aroundfor fifty years. It's the first type
of immunotherapy and the best thing wehave in bladder cancer. Not only does
it reduce the chance of recurrence,but if it comes back, it keeps
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it at a lower stage more likelyto at least and so that is the
best treatment because you know, wereduce recurrence, we reduce the risk of
missing the window of curability, soto speak, if you just wake it
up in a morning. Here onKansas Corner, we're talking with doctor Anthony
Cochran, who is a director ofurologic oncology here at NYU Land Going Health
System on Long Island and a bladdercancer expert and has done some remarkable work
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with reconstructive surgery where bladders also mayneed to be removed in some of the
locally advanced cases. I'm going totalk to you a little bit about that
because I know you really started anincredible robotic surgery program here where you can,
you know, if needed, andit's into the muscle, as you
mentioned, remove the bladder. Butit can be done with a robot and
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and then making a new bladder,which is really incredible. Tell us a
little bit about that we're lucky inurology that we have this ability to if
need be for cancer reasons, wecan take the organ out, but we
can recreate it from something that's inthe body. We don't have to do
a transplant. And if you thinkmost other cancers or organs, you can't
recreate from something in livers, kidneys, these things need pancreas, they need
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to be transplanted for the most part. So we can take a segment of
bow, if your bladder needs tobe removed, make you a new bladder
on the inside, connect your kidneytubes the urders to that, connect it
to the two VP through and itcan be a very functional reservoir to hold
urine that you can learn to emptyand manage well. And it's remarkable and
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patients can do really, really wellwith this. I've had patients say,
you know, in a direct quote, it's like my old bladder. Now
that's not everybody, but many peoplecan really reach a very high level of
functionality with that recovery and robots evenaids that recovery more, meaning we get
you through the surgery faster through thehospitalization, and you know, your prospects
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for recovering and staying out of thehospital is better. The studies have clearly
shown that there is less time inthe hospital in the recovery period and coming
back to the hospital is less ifyou have this surgery done robotically. So
these are advances now, they're youknow, still it's a procedure to go
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through and there is a healing timeand a process and retraining. But at
the end of that, you know, you really can have a good quality
of life even if you need yourbladder taken out. Yeah, I mean
this is remarkable. As you pointedout, I mean, where else in
the body can you recreate an organfrom another organ and have it functional.
And you know, as you said, I mean I make grounds as you
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know, with the residents of twicea week, and I've seen many,
many of your patients, and I'mjust amazed that. You know, when
I was training and even as ayoung faculty member taking out bladders, it
was an open incision and patients stayin the hospital at least, you know,
sometimes ten days with multiple transfusions,it's the transfusion rate that the need
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for blood is during these procedures isextraordinarily low. It's it's I don't know
what you quote patients for this,but it's it's certainly very low. And
to me to see patients that areleaving four or five days with a newly
created bladder, you know, becauseyou're one of the few, if not
the only person here on Long Islandthat's doing this completely robotically, where you're
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not only removing the bladder robotically,but you're creating this new bladder, this
neo bladder, if you will,with intestine also with the use of the
robot. And so that's really remarkableand I really have to applaud you for
that, Anthony, I really do. I you know, it's yeah,
thank you. I mean, it'sit's definitely an advancement to be able to
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do it totally instead of say,partially robotically, because you can there are
some things that you could do,you minimize, you know, stretching and
pulling on a lot of the differentstructures. But really we can give this
die that can show the blood flowto all the different you know, parts
that we're reconstructing, and it reducesthe scar tissue formation. And you know
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the scar tissue that forms that couldbe a real problem. You need another
surgery to fix that. So wereduce again not only the surgery itself and
the hospitalization, but some of thelong term side effects from the surgery as
well. And you know these arethese are advances that are helping our patients.
Oh yeah, no doubt. Let'smove on to the other area that's
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really quite interesting, which is theclinical trials. And I know you've been
involved in a lot of them,some for bladder cancer as well, and
one that you were working on thatnow has become recently because of the efforts
of the trial and it showed reallygreat results that the FDA decided to approve
it and now it's an available commerceto patients. Tell Us, tell us
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a little bit about that. So, non muscle invasive bladder cancer, when
it's yet to invade the muscle iswhere we focus on reducing the chance of
recurrence and progression of the cancer.And there are a lot of treatments and
we mentioned BCG that's the first line. There's there's other lines of treatment,
combination chemotherapies that we put in thebladder but some of the newer medicines that
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have come out can really help inthis area. One of them we were
involved in the clinical trials. It'sit's got a very difficult generic name to
say, Nana Penedicin alpha. Imean it's it's it's a real tongue twister.
But Ankiva is the is the tradename, and it's recently just started
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coming out. We we even haveexperience with it. It's it's added with
BCG to the bladder. Really,I haven't seen patients with many additional side
effects all the trials that we did, knowing which patients got it ultimately,
and we've seen that it can workreally well to help reduce rates of bladder
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cancer occurrence, reduced progression. Manypeople can live, you know, extra
years with their bladder as a resultof this. So it's really an advancement
for our bladder cancer patients and onethat we expect to have available here very
shortly, and more clinical trials tocome out of it as well for patients
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in certain scenarios where they may benefit. And you know, we just had
our big meeting, our AUA meeting, which is national international meeting, and
really the hot kind of story atthe meeting was this non muscle invasive bladder
cancer space, because it's this medicinethat we talked about and one that we
recently started giving as well, calledadstilodron again nano faradine ad novyronach for those
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who want to say the generic name, it's stilodron, and that is a
vector that carries a virus, vectorthat carries a gene that helps to ramp
up the immune system. So alsoanother treatment that can go inside the bladder
and one that's quite convenient one doseevery three months as opposed to say having
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to come back, you know,several weeks in a row, and that
for people who fail BCG treatments.This is a new innovative way we can
help you to keep your bladder andhave minimal side effects. So this space
of non muscle invasive bladder cancer iscoming out with more and more treatments to
help patients control their cancer, livewith their bladder, and it's just an
(22:44):
exciting time for us to help carefor these patients. Yeah, no,
I agree completely, and it wasa great enthusiasm as you mentioned at the
AUA this past couple of weeks,and there's you know, it's incredible to
see the research, the dollars thatare going into it, the amount of
money, and the emphasis that pharmaand industry are putting into them because they
(23:06):
see the need for it. Asyou mentioned earlier, you know, bladder
cancer can come back, and whenit comes back, you know the options
need to be expanded, and sothere's now multiple different pathways that patients can
use. And immune therapy was oneof the first tried out with bladder cancer
and it seems to be the stateof the art today just using new ways
(23:30):
of implementing it, whether it bea viral vector or whether it be something
using the immune oncology. And certainlywe've seen for advanced bladder cancers now if
they've spread beyond the bladder, someof the agents pemberlesm AB and things like
that that certainly have made a bigplayed a big role. Now haven't they
increasing survival for patients with metastatic bladdercancer. That's a different world. I
(23:56):
mean, we want to talk aboutmedicine changing on a dime. You know,
last October there was a national meetingfor the Medical Oncologist where they presented
data on the traditional chemotherapy regimen thathas been the standard of care for metastatic
bladder cancer for you know, decades, like forty plus years, versus one
(24:19):
of these immunooncology drugs, which likequi truda that I'm sure people have heard
about, and adding that with adrug called ev for short and fortuemn vedantin,
and that combination of imino oncology andin fortuemn vedantin was so compelling that
the survival rates were so much improvedthat in the middle of the of the
(24:42):
presentation, the entire huge room stoodup and clapped and you know, literally
in that moment, bladder cancer formetastatic treatment for bladder cancer that's metastatic changed
instantaneously became a new standard of care, and you just don't see anything like
that much. But you know,we've changed the non muscle bases as well
(25:06):
as the advanced state here and it'sjust, you know, great for our
patients who for years and didn't havethese options. If you are interested,
you were a loved one or afriend, or anyone that you know in
the community that has bladder cancer,you certainly need to see our expert here
at NYU Lend Going Health on LongIsland. Doctor Anthony Corkran. The number
I'll give it to you is fiveto one six five three five nineteen hundred.
(25:30):
Five one six five three five nineteenhundred. I'm sure doctor Corkan will
tell you that, you know,and he's a very humble guy, that
it's not just him that he hasso much help with of course, incredible
medical oncologists, pathologists, nurses,the pas and everyone. It's a real
big team, especially when you're doingreconstructive surgery, right Anthony, with something
(25:51):
like what you're doing to get thesepatients in and out of the hospital as
quickly as you do. I agreethat our team is to what they do
and we everyone's got their role andyou know, we all work well together
and just a pleasure to work witheveryone. Yeah, I completely agree.
And doctor Corkran is in the newbuilding in Franklin Avenue eleven eleven Franklin Avenue
(26:15):
that is in Garden City. Thenumber, again, if you are interested
for any Eurologic oncology aspect would befive one six five three five nineteen hundred.
Anthony, thanks so much. That'sthe end of the show. I
want to thank you so much forcoming on this morning, and we'll have
you on again real soon. It'sa great pleasure as always. Thank you,
thank you. Okay everyone, that'sthe end of the show. I
(26:36):
hope you enjoyed it as much asI did. Tune in every Sunday here
on kats This Corner. We'll beback next week with a great show for
you. This is doctor Aaron Kass. You've been listening to Katz's Corner.
Come back every week to hear morestraight talk on a wide range of men's
health topics and advice on how tolive your healthiest life. The proceeding was
(26:56):
a paid podcast. iHeartRadio's hosting ofthis podcast constitutes neither an endorsement of the
products offered or the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven to ten WOOR. It'sthe Chairman of Urology at NYU Land Gone
Hospital, Long Island. Here isdoctor Aaron Katz. Good morning everyone,
and welcome again to Kats's Corner hereon wr iHeartRadio. So glad you could
(00:42):
join us this morning. We havea wonderful guest who has been here on
the show before, who will betalking about an interesting topic, one that
we've discussed maybe a couple of yearsago, but there certainly has been some
rapidly new advances in the treatment andthat is of bladder cancer. And we'll
be talking with doctor Anthony Culchrin,who is the director of Urologic Oncology here
(01:04):
at the NYU Land Going Health Centeron Long Island. And Associate Professor of
urology, and he's been in thedepartment for I guess close to I don't
know, maybe ten years or so, and has really done some extraordinary work
in the field of bladder cancer diagnostics, therapy. And we'll also talk to
(01:26):
us about some new clinical trials thatwe have here in the medical center and
some really new advances that have justcome out in the last few months,
actually in the last few weeks,so really exciting stuff. Good morning,
Anthony, thanks for joining us hereon Kancers Corner. Good morning, thank
you for having me. So let'sget right into it. I guess for
(01:49):
the listeners out there, I mean, how common is bladder cancer? I
mean, we certainly hear a lotabout breast cancer and prostate cancer and men,
but you know, bladder cancer obviouslyaffecting both men and women. Common
is it now? It's fairly common. It's the sixth most common cancer that's
solid organ in you know, menand women. A little bit more common
(02:09):
in men, but it's you know, in the top ten in both sexes.
So you have to be on thelookout, and you know, we
we do see that there are certainrisk factors that people should be aware and
certain symptoms that would indicate a possiblebladder cancer. Typically that's blood in the
urine as the main sign that theremay be something going on, and certainly
(02:32):
if you have that, you needto seek medical attention. And smoking would
be the number one risk factor inboth men and women. So a history
of smoking. Many people think ifthey quit, there there without you know,
risk that risk anymore, But that'snot true. It is even if
a history of smoking, and thencertainly if you're an active smoker, both
(02:53):
of those place you at elevated riskand if you have bladder cancer. Besides,
I guess you mentioned the most commonsymptom is blood in the urine.
Are any other warning signs that peopleshould know about? Yeah? Almost always
that's what we see. But you'reright, it's not uncommon that there's no
blood in the urine and then wehave other symptoms that might pop up.
(03:16):
And the problem with that is alot of people owens, aren't thinking about
bladder cancer when it's not the mainpresenting symptom of blood in the urin.
So the ones to also be awareof are changes in urinary habits like say
frequency of urination, urgency of urination. Maybe you have to run to the
(03:37):
bathroom where you leak because you can'tget there in time. And this is
something that's new and different from whatyou've had before. Obviously, as men
get older, they do experience prostategrowth and that can cause weaker stream and
the symptoms I mentioned as well,but we have to also consider that it
(03:57):
might not be that, and thereforeseeing in your ogist and getting evaluations both
for prostate obstruction if it's a malepatient, and also things like bladder cancer
are indicated, so we check,you know, certain tests to look and
see if bladder cancer is also present. Yeah, I mean, I'm sure
(04:17):
it can be confusing, and that'swhy thankfully we have experts like you to
figure these things out. Because people, so you're saying they could have blood
in the urine, but not necessarily, they could have urinary symptoms that are
change in urinate symptoms without blood inthe urine, and then that you throw
in the smoking. I mean,smoking is very common, but I guess
(04:38):
you don't have to be a smoker, right, and you could have those
symptoms without even smoking and have bladdercancer. Correct. I mean, you
know, we all live in anindustrialized society unfortunately, and smoking isn't the
only pollutant, you know, There'sa lot of different things that we're exposed
to, you know, pollutants inthe air, pollutans in the groundwater maybe,
(05:00):
And I know that that certain partsof Long Island have higher risks of
that than others, So we haveto be aware of those nuances too.
Yeah, and you've mentioned environmental youknow, toxins. I think we've seen
a number of people here at theyou know, the medical Center, that
we're exposed down at the World TradeCenter, and I think isn't that one
of the potential risks of if youwere down there working on the pile at
(05:21):
the World Trade Center to get youknow, urinary cancers? Is that still
true? Certainly we see prostate alot of men with prostate cancer, kidney
cancer, and yes, bladder canceras well. And it's hard to link
a definite cause and result, butthere certainly is an association with that exposure.
(05:42):
Yeah. And I have to askyou because you know, so many
innovations have come out with testing andis there any you know, this may
sound silly, but are there anyhome tests? Can people just go and
check at home, go to thepharmacy, like like you get a COVID
test or something like that, ordiet test. There are blood pressure obviously
you can do it at home,and then you can do it home or
(06:03):
no, you have to go tosee the doctor for this, Well,
you should see the doctor. Certainly. There are no tests at home that
would give you a definite yes orno like a COVID test would. But
there are some tests that one couldget from, you know, over the
counter, so to speak, thatlook for blood in the urine on a
(06:25):
kind of yes no answer. Now, if there's no blood in the urine,
that doesn't mean that there's no bladdercancer. That's just looking for that,
and there can be false negatives andfalse positives. So doing the test
at home can sometimes be helpful forvarious reasons. But I think in this
particular case, certainly, if yousee blood in the urine or if you
(06:46):
have these changes, it's more nuanced, more you know, little things that
you have to sort through, andI think going to see a medical professional
obviously makes most sense. Yeah,and you got to go through the test,
right, And you could go throughthe test and of course you're going
to be angry, you know,you maybe do have blood in the urine.
Maybe you do have urinoise symptoms,but that's not one hundred percent right
what you're saying, right, Andit's not one hundred percent that you have
(07:06):
bladder cancer. But you've got togo through the testing, and that's what
we're going to talk about. Socertainly, you know there's a urine tests,
and there's image tests, and thenthere's some tests that need to require
a telescope to look into the bladder. Maybe you can tell us just briefly
about those things and has there beenany changes in those over the over the
(07:29):
last year or so. Yeah,we always get imaging because we want to
see, you know, what's goingon up in the kidneys as well as
the bladder. Imaging doesn't really lookwell at the inside of the bladder.
It kind of looks more broadly.Sometimes we don't need to do any other
tests besides the cat scan and you'rein testing. But you're right. Ultimately,
the telescope, the cystoscope looking insidethe bladder with the camera is the
(07:51):
gold standard to evaluate the bladder becausewe can miss small things in the bladder
if we don't look inside, justlike a colonoscopy to look at the lining
of a colon if you want todo it right. So I always recommend
we look inside if there's these symptoms, and that can lead to the diagnosis
of bladder cancer and many patients whootherwise may not have found it. There's
(08:11):
really nothing to replace that yet.Yeah, yeah, you're right. So
we have some urine tests and we'llget a cat skin and look inside and
then just by your eye and yourexperience, you think you know you're good
enough. At this time, you'vedone I don't know, tens of thousands
of scopes estoscopies. You can tellthat somebody has a bladder cancer just by
(08:33):
looking at it. Most commonly,yes, almost always, but sometimes there
are cases where we still want todo a biopsy for precautionary reasons. But
in the majority of cases, immediatelywe can tell if there is a cancer
or out and know that going tothe procedure suite, no cuts on the
skin, looking inside with a littlebigger camera when you're asleep. Of course,
(08:54):
to scrape the tumor out is thenext best step. Yeah, and
that can be done, and that'snot a hospitalization usually that's more of like
an outpatient type of a biopsy.Is that that typical correct in and out
the same day. We leave alittle medicine in the bladder that helps to
(09:15):
kill any free floating cancer cells.If they're there with no additional side effects,
and it's a pretty quick procedure andpretty quick recovery, then we have
a good sense of what's going on. Is it a high grade bladder cancer,
is it a low grade bladder cancer. There's differences between the two.
Low grade doesn't tend to be aninvasive tumor, whereas high grade has that
(09:37):
potential. So when we see thehigh grades, we have to make sure
we scrape deep into the bladder,into the muscle, air check the muscle,
make sure there's no involvement, becausethe muscle becomes the potential gateway for
spread to other parts of your body. So that's kind of a major difference
in bladder cancer. Is it yes, muscle invasive bladder cancer or no,
what we call non muscle invasive bladdercancer. And you know, just for
(10:03):
the listeners out there, when youdo these biopsies, and you you know,
you're said you're scraping out or you'reremoving the tumor, but you're more
removing some additional part of the ordeeper part of the bladder muscle to make
sure it's not gone in there.Does that in any way have any negative
effect on somebody's bladder functioning? Isthat? Or does it just heal over
(10:26):
and and people are fine? Thebladders are very forgiving organ Uh. In
urology we always say I wish mywife was as forgiving as the bladder.
I'd heard that it typically heals upvery nicely. Okay, So so you
can remove that tumor take what's underneathit, and then we call it,
(10:48):
we stage it, I guess,and check it, make sure it's gotten
into the bladder and then and thenit's forgiving. Uh, And it's and
then people can can move on.And do they have to have any tube
in the bladder like a catheter afterthat or or typically typically not? Okay,
tubeless? Okay, that's always nice. Yeah, we say life with
(11:09):
a bag is a drag. Soif you don't have to have a bag,
great, So that's fine. Soyou're putting some medicine and you're putting
a chemotherapy in the bladder. Isthat is that right? Is that?
Is that a new drug that you'reusing or is that the same drug?
It's been around for a very longtime, and it turns out it's very
useful in preventing recurrence. It's calledgem cido being it's just a chemotherapy that
(11:31):
stays in the bladder. There's noadditional effects. Okay, Now, one
other thing I forgot to ask you. Though we talked about smoking is a
risk and environmental what about family history? Does this run in families? Do
you see? I mean, becauseyou see so many patients with bladder cancer,
I mean, yeah, yeah,it's not a common event for this
(11:52):
to be a familial, inheritable,generational type cancer. Some you know,
that can be like kidney cancer,which retreat, but it can be that
there are certain syndromes within families,namely Lynch syndrome, which has a tendency
for bladder cancer. So certainly ifthere's a history of Lynch syndrome or typically
(12:13):
recurrent colon cancer is what happens isthe main one. Bladder cancer is also
associated with that syndrome. Mm hmmokay, all right, so typically it's
not in family, So that's okay. So we covered all of the potential
risk factors there. You think forbladder cancer, smoking clearly being the one,
(12:33):
but even if you smoked, likeyou said years ago, and not
to bring up a point again,but you said if you smoke thirty years
you're still at risk. Is thatwhat I heard? That's correct? Yeah?
Wow, there's nothing anything you cando to reduce that risk. I
mean, obviously stop smoking, butsince you've stopped smoking and you're an ex
smoker, anything that or is abody just already feeling the effects of that
(12:56):
nicotine over the years, and there'snothing. Yeah, I think the molecular
changes that have occurred because of exposureto the toxins have occurred, and then
you know, eventually they may bearthemselves out to be a cancer. And
that's probably true for smokers who allright risk for lung cancer, kidney cancer,
bladder cancer, you know, allthe very prostate cancer, all the
(13:16):
various different cancers that puts them atrisk for. Yeah. Absolutely overall.
I mean we're going to get intothe different chats, but overall, when
you're faced, you know, witha patient that has bladder cancer, and
I know this is you know,putting on the spot a little bit,
but are you hopeful if you feelthat most of these cancers are you know
that we're treating here at n YUthat you're going to cure them. We
(13:41):
have so many patients with bladder cancerand you know, of course that that
brings the fear of cancer and thetreatment effects on quality of life. But
really the overwhelming majority of patients,you know, we can manage it,
control it. It is a cancerthat tends to occur, but with the
(14:01):
treatments, we have a lot ofdifferent options. So there's not only the
first line option, there's the secondline option and so forth. So in
the majority of patients we can youknow, keep you with a good quality
of life, with your bladder intactand you know, cancer free. But
unfortunately, obviously that that's not foreveryone. I can imagine. But is
(14:22):
it like any other cancer that ifyou get it early, is it more
likely going to be curable? Then, you know, is a good chance
of curing it, even though itcould so it could come back. It
could come back in the bladder,but hopefully it's not going to spread anywhere
else than the rest of the body. Is that correct? And the treatments
that we have to reduce the chanceof recurrence, namely BCG, which is
(14:46):
putting this tuberculosis medicine in the bladderit's a form of tuberculosis. It actually
is immunotherapy. It tells your ownbody believe it or not to attack the
cancer cells. And it's been aroundfor fifty years. It's the first type
of immunotherapy and the best thing wehave in bladder cancer. Not only does
it reduce the chance of recurrence,but if it comes back, it keeps
(15:09):
it at a lower stage more likelyto at least and so that is the
best treatment because you know, wereduce recurrence, we reduce the risk of
missing the window of curability, soto speak, if you just wake it
up in a morning. Here onKansas Corner, we're talking with doctor Anthony
Cochran, who is a director ofurologic oncology here at NYU Land Going Health
System on Long Island and a bladdercancer expert and has done some remarkable work
(15:35):
with reconstructive surgery where bladders also mayneed to be removed in some of the
locally advanced cases. I'm going totalk to you a little bit about that
because I know you really started anincredible robotic surgery program here where you can,
you know, if needed, andit's into the muscle, as you
mentioned, remove the bladder. Butit can be done with a robot and
(16:00):
and then making a new bladder,which is really incredible. Tell us a
little bit about that we're lucky inurology that we have this ability to if
need be for cancer reasons, wecan take the organ out, but we
can recreate it from something that's inthe body. We don't have to do
a transplant. And if you thinkmost other cancers or organs, you can't
recreate from something in livers, kidneys, these things need pancreas, they need
(16:25):
to be transplanted for the most part. So we can take a segment of
bow, if your bladder needs tobe removed, make you a new bladder
on the inside, connect your kidneytubes the urders to that, connect it
to the two VP through and itcan be a very functional reservoir to hold
urine that you can learn to emptyand manage well. And it's remarkable and
(16:45):
patients can do really, really wellwith this. I've had patients say,
you know, in a direct quote, it's like my old bladder. Now
that's not everybody, but many peoplecan really reach a very high level of
functionality with that recovery and robots evenaids that recovery more, meaning we get
you through the surgery faster through thehospitalization, and you know, your prospects
(17:08):
for recovering and staying out of thehospital is better. The studies have clearly
shown that there is less time inthe hospital in the recovery period and coming
back to the hospital is less ifyou have this surgery done robotically. So
these are advances now, they're youknow, still it's a procedure to go
(17:29):
through and there is a healing timeand a process and retraining. But at
the end of that, you know, you really can have a good quality
of life even if you need yourbladder taken out. Yeah, I mean
this is remarkable. As you pointedout, I mean, where else in
the body can you recreate an organfrom another organ and have it functional.
And you know, as you said, I mean I make grounds as you
(17:49):
know, with the residents of twicea week, and I've seen many,
many of your patients, and I'mjust amazed that. You know, when
I was training and even as ayoung faculty member taking out bladders, it
was an open incision and patients stayin the hospital at least, you know,
sometimes ten days with multiple transfusions,it's the transfusion rate that the need
(18:11):
for blood is during these procedures isextraordinarily low. It's it's I don't know
what you quote patients for this,but it's it's certainly very low. And
to me to see patients that areleaving four or five days with a newly
created bladder, you know, becauseyou're one of the few, if not
the only person here on Long Islandthat's doing this completely robotically, where you're
(18:34):
not only removing the bladder robotically,but you're creating this new bladder, this
neo bladder, if you will,with intestine also with the use of the
robot. And so that's really remarkableand I really have to applaud you for
that, Anthony, I really do. I you know, it's yeah,
thank you. I mean, it'sit's definitely an advancement to be able to
(18:56):
do it totally instead of say,partially robotically, because you can there are
some things that you could do,you minimize, you know, stretching and
pulling on a lot of the differentstructures. But really we can give this
die that can show the blood flowto all the different you know, parts
that we're reconstructing, and it reducesthe scar tissue formation. And you know
(19:18):
the scar tissue that forms that couldbe a real problem. You need another
surgery to fix that. So wereduce again not only the surgery itself and
the hospitalization, but some of thelong term side effects from the surgery as
well. And you know these arethese are advances that are helping our patients.
Oh yeah, no doubt. Let'smove on to the other area that's
(19:40):
really quite interesting, which is theclinical trials. And I know you've been
involved in a lot of them,some for bladder cancer as well, and
one that you were working on thatnow has become recently because of the efforts
of the trial and it showed reallygreat results that the FDA decided to approve
it and now it's an available commerceto patients. Tell Us, tell us
(20:00):
a little bit about that. So, non muscle invasive bladder cancer, when
it's yet to invade the muscle iswhere we focus on reducing the chance of
recurrence and progression of the cancer.And there are a lot of treatments and
we mentioned BCG that's the first line. There's there's other lines of treatment,
combination chemotherapies that we put in thebladder but some of the newer medicines that
(20:26):
have come out can really help inthis area. One of them we were
involved in the clinical trials. It'sit's got a very difficult generic name to
say, Nana Penedicin alpha. Imean it's it's it's a real tongue twister.
But Ankiva is the is the tradename, and it's recently just started
(20:48):
coming out. We we even haveexperience with it. It's it's added with
BCG to the bladder. Really,I haven't seen patients with many additional side
effects all the trials that we did, knowing which patients got it ultimately,
and we've seen that it can workreally well to help reduce rates of bladder
(21:08):
cancer occurrence, reduced progression. Manypeople can live, you know, extra
years with their bladder as a resultof this. So it's really an advancement
for our bladder cancer patients and onethat we expect to have available here very
shortly, and more clinical trials tocome out of it as well for patients
(21:30):
in certain scenarios where they may benefit. And you know, we just had
our big meeting, our AUA meeting, which is national international meeting, and
really the hot kind of story atthe meeting was this non muscle invasive bladder
cancer space, because it's this medicinethat we talked about and one that we
recently started giving as well, calledadstilodron again nano faradine ad novyronach for those
(21:56):
who want to say the generic name, it's stilodron, and that is a
vector that carries a virus, vectorthat carries a gene that helps to ramp
up the immune system. So alsoanother treatment that can go inside the bladder
and one that's quite convenient one doseevery three months as opposed to say having
(22:18):
to come back, you know,several weeks in a row, and that
for people who fail BCG treatments.This is a new innovative way we can
help you to keep your bladder andhave minimal side effects. So this space
of non muscle invasive bladder cancer iscoming out with more and more treatments to
help patients control their cancer, livewith their bladder, and it's just an
(22:44):
exciting time for us to help carefor these patients. Yeah, no,
I agree completely, and it wasa great enthusiasm as you mentioned at the
AUA this past couple of weeks,and there's you know, it's incredible to
see the research, the dollars thatare going into it, the amount of
money, and the emphasis that pharmaand industry are putting into them because they
(23:06):
see the need for it. Asyou mentioned earlier, you know, bladder
cancer can come back, and whenit comes back, you know the options
need to be expanded, and sothere's now multiple different pathways that patients can
use. And immune therapy was oneof the first tried out with bladder cancer
and it seems to be the stateof the art today just using new ways
(23:30):
of implementing it, whether it bea viral vector or whether it be something
using the immune oncology. And certainlywe've seen for advanced bladder cancers now if
they've spread beyond the bladder, someof the agents pemberlesm AB and things like
that that certainly have made a bigplayed a big role. Now haven't they
increasing survival for patients with metastatic bladdercancer. That's a different world. I
(23:56):
mean, we want to talk aboutmedicine changing on a dime. You know,
last October there was a national meetingfor the Medical Oncologist where they presented
data on the traditional chemotherapy regimen thathas been the standard of care for metastatic
bladder cancer for you know, decades, like forty plus years, versus one
(24:19):
of these immunooncology drugs, which likequi truda that I'm sure people have heard
about, and adding that with adrug called ev for short and fortuemn vedantin,
and that combination of imino oncology andin fortuemn vedantin was so compelling that
the survival rates were so much improvedthat in the middle of the of the
(24:42):
presentation, the entire huge room stoodup and clapped and you know, literally
in that moment, bladder cancer formetastatic treatment for bladder cancer that's metastatic changed
instantaneously became a new standard of care, and you just don't see anything like
that much. But you know,we've changed the non muscle bases as well
(25:06):
as the advanced state here and it'sjust, you know, great for our
patients who for years and didn't havethese options. If you are interested,
you were a loved one or afriend, or anyone that you know in
the community that has bladder cancer,you certainly need to see our expert here
at NYU Lend Going Health on LongIsland. Doctor Anthony Corkran. The number
I'll give it to you is fiveto one six five three five nineteen hundred.
(25:30):
Five one six five three five nineteenhundred. I'm sure doctor Corkan will
tell you that, you know,and he's a very humble guy, that
it's not just him that he hasso much help with of course, incredible
medical oncologists, pathologists, nurses,the pas and everyone. It's a real
big team, especially when you're doingreconstructive surgery, right Anthony, with something
(25:51):
like what you're doing to get thesepatients in and out of the hospital as
quickly as you do. I agreethat our team is to what they do
and we everyone's got their role andyou know, we all work well together
and just a pleasure to work witheveryone. Yeah, I completely agree.
And doctor Corkran is in the newbuilding in Franklin Avenue eleven eleven Franklin Avenue
(26:15):
that is in Garden City. Thenumber, again, if you are interested
for any Eurologic oncology aspect would befive one six five three five nineteen hundred.
Anthony, thanks so much. That'sthe end of the show. I
want to thank you so much forcoming on this morning, and we'll have
you on again real soon. It'sa great pleasure as always. Thank you,
thank you. Okay everyone, that'sthe end of the show. I
(26:36):
hope you enjoyed it as much asI did. Tune in every Sunday here
on kats This Corner. We'll beback next week with a great show for
you. This is doctor Aaron Kass. You've been listening to Katz's Corner.
Come back every week to hear morestraight talk on a wide range of men's
health topics and advice on how tolive your healthiest life. The proceeding was
(26:56):
a paid podcast. iHeartRadio's hosting ofthis podcast constitutes neither an endorsement of the
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