Latest developments in bladder cancer research: what it means for patients

On Public Day of the World Bladder Cancer Patient Forum 2026 in Hong Kong, two members of our Scientific Advisory Board presented Latest developments in bladder cancer research: Prof. Jeremy Teoh, Professor and Assistant Dean (External Affairs) at the Faculty of Medicine, The Chinese University of Hong Kong and Vice Chair of the Board, and Dr Makarand Khochikar, Head of Urology and Urologic Oncology at KIMS Hospital, Sangli, and Chief Uro-oncologist at Siddhi Vinayak Ganapati Cancer Hospital, Miraj, who has spent three decades treating bladder cancer in India.

The question that is keeping surgeons awake

Dr Khochikar took on muscle-invasive bladder cancer (MIBC), where the cancer has grown into the muscle wall of the bladder. For decades the answer was to remove the bladder, an operation called a radical cystectomy. What has changed is everything around that operation:

• Chemotherapy before surgery is now standard. It shrinks the tumour, makes the operation easier, and adds roughly 5 to 7% to survival.
• Immunotherapy is being added to it. Treatment that helps the immune system attack the cancer, tested in trials such as NIAGARA, shows a clear survival benefit when combined with chemotherapy before surgery.
• Patients who cannot have chemotherapy now have options. Those whose kidneys cannot tolerate standard chemotherapy can be offered newer combinations, with strong results.

Then came the twist. Some patients respond so completely that scans show no cancer left at all. Their bladders are removed anyway, and the laboratory confirms afterwards there was nothing there to remove. “The patients keep asking, if the disease is gone completely, why are we removing the bladder?” Dr Khochikar said, calling it the question now haunting clinicians.

He described his own career as a full circle. Thirty years ago he travelled the world learning how to remove bladders. Today he is asking whether he should still be teaching younger surgeons to do it. The answer lies in better selection, using biomarkers and liquid biopsies (tests that look for tiny fragments of tumour DNA) to identify who genuinely needs surgery and who can safely keep their bladder.

He added a warning about cost. A radical cystectomy cost around US$ 45,000 in 2003. Modern combinations of chemotherapy and immunotherapy run into the hundreds of thousands of dollars per patient, before the cost of managing side effects is counted. Wonderful treatments are arriving, but someone has to be able to afford them.

What thirty years of patients have taught him

The second half of his talk was not about drugs at all, and it was the part the room will remember.

In India, many families pay for cancer care themselves, sometimes selling their house or savings. The costs do not stop when treatment ends: a patient with a urostomy (an opening on the abdomen where urine drains into a bag) spends around US$ 20 to 30 every week, for life, on bags and adhesive flanges. So Dr Khochikar changed his surgical technique to make the stoma spout slightly longer, stopping urine from degrading the adhesive. A flange that lasted five or six days now lasts around fifteen. Same cancer outcome, half the ongoing cost.

Then there is what kind of life people can live afterwards. He described Muslim patients who feared they could no longer attend the mosque, Hindu and Buddhist patients whose temple customs require removing their upper clothing, and women wearing saris, where a urine bag is visible to everyone.

One of those women, a vegetable vendor, came back two weeks after a technically perfect operation and told him: “You cured me, but you killed me as well.” Customers would not come near her stall. His wife, a gynaecologist, made her a pouch from sari fabric that hides the bag completely and doubles as somewhere to keep her money, phone and cards. She went back to work, and nobody can tell.

His patients designed the rest themselves: trousers with a hidden slit so a man could use a public toilet unnoticed, an old school bag cut down and cushioned so another could swim again, a stoma placed on the opposite side so a keen golfer could keep his swing, and a juggler who worked his stoma into his act. Dr Khochikar has set up a foundation to help patients access these adaptations, and was clear about the credit: “You are guiding and teaching us.”

Why non-muscle-invasive bladder cancer keeps coming back

Prof. Teoh took on non-muscle-invasive bladder cancer (NMIBC), the large majority of cases, and opened with the question he puts to his trainees: is bladder cancer a good cancer or a bad cancer?

Both, and that is the paradox. A higher-risk patient might face a 38% chance of the cancer returning within a year, yet only around a 1% chance of it progressing in that same year. Highly controllable, but relentlessly recurring, which means repeated procedures and a lifetime of camera checks.

So he asked the more useful question: why does it come back, and is that the tumour’s fault or ours? He broke it into five mechanisms, each with its own answer:

• The tumour was never seen. Small tumours get missed during a cystoscopy (a camera examination inside the bladder). Enhanced imaging helps surgeons see what standard white light misses.
• Some of it was left behind. It is hard to judge during surgery whether the whole tumour has gone, which is why many patients are offered a second procedure a few weeks later.
• Loose cells re-attached. Removing a tumour in fragments releases cells that float and settle elsewhere. A single dose of chemotherapy into the bladder straight after surgery helps mop them up.
• The whole bladder lining is affected. Carcinogens from smoking and other exposures are filtered into the urine, bathing the entire lining. That is why BCG is given over a year rather than as a single dose.
• Cells dropped down from higher up. A tumour in the kidney or ureter can shed cells into the bladder. Uncommon, and usually ruled out by a scan beforehand.

Changing how the surgery is done

Conventional surgery removes a bladder tumour in pieces, which is easier for the surgeon but scatters cells. Prof. Teoh’s alternative, en bloc resection, removes it in one piece.

His trial across 13 centres in Hong Kong with 350 patients compared the two approaches using the same surgeons and equipment. One-year recurrence fell from 38.1% to 28.5%. Every urology resident in Hong Kong is now trained in the technique, and a research registry has collected data on more than 4,000 patients. Combining it with BCG in high-risk patients brought one-year recurrence to around 5% in a small group, now being tested in two larger trials.

On newer drugs for patients whose cancer returns despite BCG, he gave a clear-eyed tour: a slow-release device placed inside the bladder, immunotherapy by infusion, a gene-based therapy given once every three months, and an immune-boosting agent still unavailable across much of Asia. All promising, all requiring an honest conversation with each patient about benefit, side effects, hospital visits and cost.

He closed on the surveillance burden patients raise constantly: camera checks every three months for two years, then every six months, then annually for life. His panel read 1,760 studies looking for evidence that urine tests could safely replace some of those checks, and found only a handful of randomised trials. Encouraging, but not yet strong enough to change practice. His message to industry was pointed: this is not about selling something, it is about generating the evidence that changes patients’ lives.

The thread running through both talks

The science is moving faster than it has in decades, and for many patients that will mean better survival and, increasingly, keeping their bladder. But a treatment nobody can afford, a follow-up schedule that swallows a life, or an operation that leaves someone unable to work or worship is not a solved problem. Progress is measured in how people live afterwards.

Want to understand your options better? Read more about bladder cancer, its stages and treatments on our website, and explore the work of our Scientific Advisory Board.