Bladder cancer is one of the most common cancers, impacting nearly 70,000 adults in the US each year. Dr. Martha Terris and Dr. Vinata Lokeshwar from the Medical College of Georgia are focused on the disease’s diagnosis and treatment, and share their expertise with viewers of The Means Report.

Brad Means: So let’s cover bladder cancer, shall we? Doctor Martha Terris, chairs the urology division at MCG. Doctor Terris.

Dr. Martha Terris: Thank you!

Brad Means: Thank you so much for what you do.

Dr. Martha Terris: Thank you for having me!

Brad Means: Not only for our students, but for our patients. Yeah, you’re welcome! Anytime! We appreciate it. And Doctor Vinata Lokeshwar who is the chair of the Department of Biochemistry and Molecular Biology at The Medical College of Georgia. Thanks.

Dr. Vinata Lokeshwar: Thank you for having us.

Brad Means: So you can be my what are we doing on the testing research side of bladder cancer things, if that’s acceptable, and you can be my what in the world is bladder cancer and what do you do if you have it. And so, we’ll start with that. It affects about 68,000 people every year. How do you know you have bladder cancer versus something else and it’s time to probably go get it checked out?

Dr. Martha Terris: Right. Those are all good questions. Bladder cancer is a cancer that occurs in the inner lining of the bladder. The bladder is like a sac that holds your pee and empties when you’re ready to pee, and then fills back up again. And it has several layers: an inner lining, and then a couple of muscle layers. And, bladder cancer occurs in that inner lining. And we think it’s most commonly caused by toxic chemicals in the urine. The most common is nicotine products from smoking, so the most common risk factor we see for bladder cancer is smoking. The biggest sign of bladder cancer that we see is blood in the urine. That’s the most common thing that bring people to us. Unfortunately, many times, people go to a clinic and have blood in their urine, and are told, oh, it’s just a bladder infection, here’s some antibiotics.

Brad Means: Right.

Dr. Martha Terris: Come back in a few months, and that’s the wrong answer, especially in a smoker, ’cause it could be something much, much more serious.

Brad Means: All right, so if you see blood in the urine, go to the doctor right away.

Dr. Martha Terris: Correct.

Brad Means: What’s it look like? Your urine is red?

Dr. Martha Terris: Your urine can be red, your urine can be iced tea-colored for older blood, but typically it’s red.

Brad Means: Doctor Lokeshwar, how do you test for bladder cancer? Is it still a urine test? Is it a blood test now? Both?

Dr. Vinata Lokeshwar: Well, currently, bladder cancer is detected by something called cystoscopy. And Doctor Terris will tell you that. And just imagine a long tube is inserted through your urethra and the urologist kind of looks into your bladder for tumors. It’s invasive, painful, and it could have procedure-related morbidity. So, the impeders has always been can you find a urine test for bladder cancer, which would be non-invasive, it would not be expensive, and it wouldn’t have side effects because it’s just testing urine specimen from a patient.

Brad Means: Yeah, aren’t there tests we can buy over the counter to test for bladder cancer or on the internet? If so, how reliable were those?

Dr. Martha Terris: No, unfortunately not. There have been many attempts to create bladder cancer tests that obviate the need for this cystoscopy procedure but none have proven specific enough to get away from the uncomfortable procedures that we perform.

Brad Means: All right, so, if we’re able to move more to the urine testing option when it comes to bladder cancer detection, what are you looking for? You actually, Doctor Lokeshwar, discovered a gene about a decade ago, V1. I don’t know much about it to speak intelligently on it other than to give you credit and to thank you for that, but is that what you’re looking for if these urine tests are successful?

Dr. Vinata Lokeshwar: That is correct. And normally, in a urine test, you would look at proteins that are coming because the tumor is always bathing in urine. And so, products from the tumor can be secreted in urine, and you could test them if they are tumor-specific. At the same time, just like we shed our skin cells, when we dry our skin with a towel, we are shedding skin cells. The same thing, tumor cells can be shed in urine, when the urine is stored in the bladder. And you could test for those cells with genetic testing, or another type of protein testing, and those are the urine-based tests. So, our test is two-part test. One is you can detect the protein and the activity of that protein in urine and this protein is secreted in the urine. At the same time, we can look at how this gene is present or expressed in cancer cells that are bladder cancer cells, and based on the level of the expression of that gene in those tumorous cells, we can say whether the patient has cancer or not. And the beauty of this two-part test is, and Doctor Terris can elaborate a little bit on the biology of the bladder tumor, is the test that we are detecting the protein in the urine, which is the part of the V1 protein, it actually detects all kinds of bladder cancer. It detects both low-grade bladder cancer which is not that life-threatening, as opposed to high-grade bladder cancer, which would be has not a good prognosis for the patient. And the V1 test that you talked about, V1 is actually looking for and detecting with high accuracy high-grade bladder cancer. So, in a one test, in this two-part test, you can detect bladder cancer and noninvasively determine the patient has high-grade bladder cancer.

Brad Means: If the testing procedures are improved, Doctor Terris, might we have better outcomes for our patients? Is that the overall hope here?

Dr. Martha Terris: Absolutely. So, we can detect cancers when the patient comes in with blood in their urine, although the test is uncomfortable. But being able to look at a cancer and say, oh, this one’s gonna be life-threatening, we need to be very aggressive, maybe we need to do surgery and chemotherapy or some other combination therapy to get you free of this cancer, it’s guess work right now. And if we have a predictive marker that can tell us this one’s gonna be a bad actor, and this one’s gonna just sit there and behave itself, then that helps me to decide how aggressively to treat a patient.

Brad Means: Can you manipulate those genes or those proteins? Potentially, I don’t wanna get ahead of myself, but one day so that maybe the cancer doesn’t even develop?

Dr. Vinata Lokeshwar: Absolutely. So, the thing is, so is this V1 just a marker or is it a driver of the cancer?

Brad Means: Right.

Dr. Vinata Lokeshwar: And the answer is yes, it’s a driver of the cancer. Actually, we have data and we have our publications that we wanna put it in, so I won’t go too much into detail about how the complicated technology that we have used. But this gene, if you artificially put into normal bladder cells, they actually can become tumorigenic. So it’s truly driving bladder cancer and it’s truly driving its spread into organs, which is we call mastocytosis. So as I’m hoping, that once we know how this gene is working, and we could develop inhibitors as therapeutic to curb this protein down so that it could have a better outcome, so it could have a better therapeutic, a V1-based therapeutic, that’s what we want to drive.

Brad Means: Okay, so until Doctor Lokeshwar’s best case scenario comes true, how do you treat bladder cancer? You said surgery. Do you mean zap the tumor or take the bladder out?

Dr. Martha Terris: So, it depends. It depends. So you can go through the urethra with the patient asleep, and trim the tumor out. And for most tumors, that’s good enough. Some tumors–

Brad Means: It’s gone. The cancer’s gone.

Dr. Martha Terris: The cancer’s gone, although it has a high propensity to come back. So sometimes we’ll put chemotherapy in the bladder, with a catheter on a regular basis to prevent it from coming back. Others, the cancer is very mean and aggressive and it’s put roots down through that inner lining into the muscle and that’s when we’re in trouble. That’s when the patient needs, not chemotherapy in the bladder, but through a drip, through their whole system, they’re at risk for having metastasis throughout their body. And once that chemotherapy is done, we take out the bladder.

Brad Means: Here’s the thing about bladder cancer that I find alarming. It’s not just exposure to tobacco, it’s not necessarily a genetic predisposition to it, it’s that there are so many chemicals out there that can lead to it.

Dr. Martha Terris: Absolutely.

Brad Means: How do you stay safe? How do you prevent?

Dr. Martha Terris: That’s the thing. If you stay home and hide in a closet, I guess, would be the only way, because, petroleum palm products, ash from fires, textiles, certain dyes, there’s a million different potential risk factors for it and we know cigarette smoking, or smoking anything, for that matter, so if you smoke something else, that could do it too. But that one we know but there’s a lot out there we’re still finding out.

Dr. Vinata Lokeshwar: So that’s why the testing, that type of test, as we talked about cystoscopy where you look into the bladder when the tumor is there, but the molecular tests are much more sensitive. Even before you see a visible tumor, if you can detect a tumor way before, it’s actually gonna come back. As we said, that when you remove the tumor from the bladder, it can come back called recurrence. So, the molecular test suggests the V1 test actually can detect the tumor six months before a urologist can actually detect it by cystoscopy. So earlier you detect, the better is the treatment.

Brad Means: Yeah, but the less surgeries for her, you’re gonna put your boss out of business if you’re not careful.

Dr. Vinata Lokeshwar: Well, she’s my colleague, not my boss.

Dr. Martha Terris: Not at all!

Dr. Vinata Lokeshwar: Not boss. We are colleagues.

Brad Means: Doctor Lokeshwar, that’s on me, and I apologize for that. Everybody at MCG is a colleague, I suspect. Real quickly, 15 seconds, you testing on humans yet, animals yet, or is it too early?

Dr. Vinata Lokeshwar: So this is all in human patients. So we are testing–

Brad Means: Way to go!

Dr. Vinata Lokeshwar: Urine specimens on all the human patients and that’s why I have a National Institute of Cancer NIH Grant to test it for five years and as well as from the Department of Defense, I have a grant to bring forward this V1. We’ve worked on it for 10 years.

Brad Means: Working with about $3 million right now.

Dr. Vinata Lokeshwar: Yes, that’s correct.

Brad Means: Right? I hope you cure bladder cancer. You, and your colleagues need to cure it.

Dr. Vinata Lokeshwar: Well, thank you very much.

Brad Means: Absolutely, and in the meantime thanks for the treatment and the hope you give to patients.

Dr. Martha Terris: Absolutely.

Brad Means: Doctor Terris, Doctor Lokeshwar, y’all were great. You did break it down as I promised that you would, and I’m grateful for that.

Dr. Vinata Lokeshwar: Thank you very much.

Dr. Martha Terris: Thank you!