SUMMARY
With the recent announcement by Deion Sanders, hall of fame NFL player and current head coach for the University of Colorado Buffaloes, that he is undergoing treatment for bladder cancer, we’ve been seeing a significant increase in interest about the disease. Today’s guest is Dr. Bradley Gill, chief of surgery at Cleveland Clinic Hillcrest and Mentor Hospitals and a board-certified urologist, to help us understand the condition, its causes, treatment options and potential outcomes.
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Transcript
The following transcript was generated electronically. Please let us know if you see any transcribing errors and we’ll get them corrected immediately.
Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers. All available at nafc.org.
Welcome back to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us today is Dr. Bradley Gill. He’s the chief of surgery at Cleveland Clinic Hillcrest and Mentor Hospitals and a board-certified urologist. He specializes in things like benign prostatic enlargement, male voiding dysfunction, erectile dysfunction surgery, neuromodulation, advanced surgical techniques, and well, if you can guess from that list of things, a lot of things that have to deal with male bladder, bowel incontinence issues, and that’s why we’re particularly interested in speaking with Dr. Gill today because there’s been some news recently about bladder issues that I think a lot of our listeners are going to want to hear about. So, Dr. Gill, thank you for joining us.
Dr. Gill: Thanks for having me. Looking forward to being here.
Bruce Kassover: Excellent. Now, one of the things that many of our listeners may have heard is that Deion Sanders, Hall of Fame NFL Football player, coach at Colorado, ‘Coach Prime’ as he’s known just announced that he has bladder cancer and he’s been undergoing treatment for that. And I get the feeling that when it comes to cancers, there are a lot of cancers out there that get a lot of attention. And there are some that don’t get much at all, and bladder cancer seems to be one of them. Is this something that is, is bladder cancer something that’s relatively common?
Dr. Gill: You know, Bruce, you’re spot on. So bladder cancer actually is not that uncommon. If you look at the statistics for it, it’s the 10th leading cause of cancer death in the United States. So it, it really is fairly common in a urology practice, but maybe not in everyday life, you know, talking amongst friends and family.
I just pulled up the 2025 statistics from the American Cancer Society and they reported over 84,000 new cases of bladder cancer were diagnosed in the United States. And about 17,000 almost 18,000 deaths occurred from bladder cancer. And that was just in one year alone. So bladder cancer really is not that uncommon, although it’s not really talked about very often.
Bruce Kassover: Then let’s talk about it a little bit. What are the symptoms that somebody might experience that would lead them to even see a doctor and potentially get a diagnosis of bladder cancer?
Dr. Gill: It’s a very good question. So bladder cancer, much like prostate cancer, another common disease in urology, is one of those cancers that may not cause big symptoms until it’s very advanced or potentially too late to be managed. One of the things though, that could be a tip off to bladder cancer is blood in the urine.
So blood in the urine is never normal. If you ever see blood in the urine, you have to see a urologist. If it’s visible, if the urine’s red, you need to see a urologist. You really need to be checked. If there’s blood in the urine on a dipstick test, a routine screening test, that’s done by a lot of primary care teams, that’s something that warrants further workup as well, and it may, you know, be testing, looking more at the urine. It may involve a CAT scan or things like that, but that itself can be a tip off or a potential early sign of bladder cancer, too.
Bruce Kassover: That certainly makes sense and I’d like to think if anybody does see blood in the urine, that they would be motivated to see a physician. Are there other things that aren’t necessarily urine related and like pain, discomfort, anything of that nature that might also be a signal.
Dr. Gill: So like prostate cancer, if you’re having other symptoms from a bladder cancer, chances are it’s very advanced. If you have pain in the lower abdomen, near the bladder, in the pelvis, that could be due to cancer that’s growing into the bladder or invading other structures.
If you have back pain or side pain, that could be indicative of the cancer growing into or blocking up the ureter, the tube that drains the urine from the kidney down to the bladder. And that pain can be a sign of urine backup into the kidney. Other signs like weight loss lumps or bumps, different places in the body, those would be indicators of very advanced bladder cancer, what we’d consider to be metastatic ,disease. But, you know, again, blood in the urine is one of the, the early signs of bladder cancer in something that we can use to diagnose it hopefully when it, today, a very early, very low stage when it can be easily managed.
Bruce Kassover: Okay. Now we’ve spoken a lot on this podcast about prostate cancer. And one of the things that I think a lot of people find surprising about prostate cancer is that it doesn’t seem to be necessarily very aggressive for many men. You know, it’s the sort of thing where they can get a diagnosis and through maintenance and management and monitoring, they can, you know, just sort of keep an eye on things and only seek treatment when it seems like it’s becoming more aggressive. Is bladder cancers anything like that?
Dr. Gill: It’s a very good question. You know, what you’re referring to is active surveillance for prostate cancer. So, as you mentioned, very low grade on aggressive prostate cancers. You can safely observe and monitor with PSAs on an interval basis, and MRIs and testing like that. Bladder cancer is the exact opposite. So, if there’s a bladder cancer in there, you need to get it out. And the way that’s done initially is with a scope-based procedure in an operating room with a patient asleep, you go in and you just scrape out or cut out the cancer from the bladder to get a diagnosis. And based on that diagnosis, similar to what you’re describing with the prostate cancer, we look at the risk that that bladder cancer is.
Is it low grade disease? Is it high grade disease? Was it a large tumor? Was it a small tumor? But most importantly, did it grow into the bladder muscles or was it just what we call superficial, on the lining of the bladder? And all of those different factors help us risk stratify that cancer. They help us determine whether it’s something that we can just monitor and watch for with an occasional bladder scope and a urine test or if it’s something that’s more substantial that would even warrant going back in and doing another biopsy or another bladder scraping with a scope to confirm that, you know, that cancer was successfully removed.
Bruce Kassover: Okay, so the cancer has been diagnosed. You’ve done that removal process and, as you mentioned, in some cases you may have to do further work on the patient to address the cancer. What sort of treatments would a patient likely see, or what sort of range of treatments might a patient see?
Dr. Gill: I like the word range there and that’s really a great way to think about it. So the, the least aggressive bladder cancers you go in, you clean them out with a scope, and then you keep an eye on things.
The most aggressive bladder cancers you may need to go in and remove the entire bladder and the prostate and potentially even part of the urethra with that. And that really is quite a range of surgery. And then in the middle there, there’s what’s called “bladder sparing treatment,” where you can try to go in, scrape out as much cancer as you’re able to with a scope, and then use a combination of chemotherapy and radiation to try to destroy any remaining cancer cells.
With that bladder removal surgery, oftentimes chemotherapy is given before that to help shrink the tumor and raise the chances of successfully getting it all out. There’s also things like immunotherapy, where newer treatments can be used to turn the immune system against the cancer cells and help fight it that way.
So there really is quite a, quite a range of treatments there. My practice in particular dealing with quality of life, I often will help take care of patients who have had bladder cancer treatment who may be experiencing incontinence issues or problems with sexual function, those type of issues.
You know, from a cancer treatment standpoint I’m fortunate to be part of a very large team where I have a number of partners who do nothing but cancer treatment. And really that’s a kind of a neat thing about urology. There’s so many specialties or subspecialties within urology that we can oftentimes align patients with providers who are very specialized and have a very deep knowledge in the area of care that they need.
Bruce Kassover: So you mentioned earlier that one of the potential treatments is, is actually bladder removal. That sounds like a pretty drastic thing. What, what is that like and, and what is quality of life afterwards?
Dr. Gill: Yeah, so cystectomy, or bladder removal, it’s probably one of the biggest surgeries that urologists do, and the goal there is to really get all of the cancer out, but then the remainder of the bladder too, because it may be more prone to forming cancer, having cancer recur.
So a lot of patients hear that and they, they panic saying, “Hey, you’re taking out my bladder. What am I going to do? How am I going to live like that?” And believe it or not, patients that have had their bladder taken out and had either a new bladder constructed with intestine or had what’s called a ‘urostomy,’ or a small urine pouch that they wear under a shirt on their belly, their quality of life is extremely high.
And one of the myths that I often dispel in, in clinic talking with patients is that having a urostomy is going to be a limiting factor for them. You know, they’re concerned about body image, about having a pouch on the front of their belly. And you know, there’s great research out there that shows that folks with urostomy have just as good of quality of life as folks who you know, don’t. And they can do any activity. They can play sports, they can go swimming. The urostomy appliances nowadays, the little pouches, are very low profile. They’re discreet, they’re easy to hide under a shirt. So it’s not uncommon for folks to go out in public and do what they enjoy and have no one else around them even know that, that urostomy or that that urine bag is there.
Bruce Kassover: Does it impact sexual function?
Dr. Gill: Excellent question. So, sexual function when you’re removing the bladder, you remove the prostate in men, and the nerves that, contribute to erections or control erections are on the sides of the prostate. So most men, if they have to have a radical cystoprostatectomy, or removal of the bladder and prostate, will have problems with erections. And that’s something that a urologists have a lot of different things to help with. You know, tongue in cheek, I’ll tell my patients where there’s a will, there’s a way. We have things we can do to help restore sexual function.
And then on the female side, when you go and you take out the bladder, oftentimes you take the urethra and the front portion of the vaginal wall out with that. That’s an evolving area in urology right now. So what’s being done a lot of places is ‘vaginal sparing cystectomy,’ so that you’re able to preserve the organs for sexual function. Sometimes, as with any cancer, the cancer may be too advanced or too big, and you may have to still take the urethra or that part of the vagina out with the bladder. But in cases like that, there’s some reconstructive procedures that can be done to help restore the anatomy and hopefully preserve or maintain sexual function.
Bruce Kassover: And I suppose in the end, it’s better than the alternative.
Dr. Gill: It is far better than the alternative. Obviously the alternative being, you know, progression of cancer and then with bladder cancer in a lot of cases mortality or death. It’s a, it’s a very dangerous disease.
Bruce Kassover: When you think about outcomes, you know, if we think about cancers, I just, in my own head, you know, picture like this, this range of outcomes for various cancers, like, you know, skin cancers, for example, are often very treatable. And then you have on the opposite end things like pancreatic cancer that’s often, you know, caught so late that it’s very rarely successfully treated. Where on that sort of spectrum does bladder cancer fall?
Dr. Gill: So, bladder cancer historically was a very, very dangerous cancer. It had high mortality rates and patients, unfortunately did not do very well.
Looking at the updated data, you know, on the American Cancer Society website, they have a a five-year relative survival rate table there. And if you find a bladder cancer that’s just in the bladder, it hasn’t gone anywhere else, those survival rates can be, you know, in the 70 plus percent range. If you have bladder cancer that’s grown into the bladder or maybe gotten into the tissues right around it, but it’s able to be all removed with a surgery, you’re looking at roughly a 40% five-year survival for that. And then if you have bladder cancer that spread beyond the bladder into the lymph nodes, into the lungs, into another part of the body, you’re looking at a very, very low potential there for five-year survival; it’s, it’s only about 9%.
But some of the hopes we have for these numbers improving, relate to the newer treatments, the newer therapies that are coming out, things like immunotherapy, which have shown promise and you know, there’s continually new clinical trials and new things being looked at to try and give our patients with bladder cancer hope.
Bruce Kassover: And I guess that’s no better endorsement for seeking help early and really paying attention to your body and, and taking an active role in doing things, certainly before they become far more dangerous.
Dr. Gill: Exactly. And taking it even a step back, you know, thinking about prevention, oftentimes if a patient is diagnosed with cancer, they’ll ask their team during the consult, “Hey, what could I have done to prevent this? Is there anything, you know, I, I should have done differently?” What we know about bladder cancer is the number one risk factor is tobacco use and smoking. So smoking cessation, trying to avoid tobacco use, it plays a huge role in reducing the risk for bladder cancer formation. There’s also some occupational exposures, industrial chemicals radiation, so forth and so on that can impart a risk of bladder cancer. And, you know, on that end, obviously, making sure that you use the appropriate safety gear, protective equipment at work and those kind of things. But hands down, the number one risk, modifiable risk for bladder cancer that we see in patients is, is smoking and tobacco use.
Bruce Kassover: That’s fascinating. I mean, when they say lung cancer comes from smoking, that seems obvious, but bladder cancer, wow, that’s amazing. Your body really is a remarkable thing, isn’t it?
Dr. Gill: It is. It is. And what we think is that the carcinogens from smoking, they get into the body, into the bloodstream, and then as they’re filtered out of the body, they go through the kidneys and potentially drain down into the urine, which then sits in the bladder and allows those chemicals to act in the lining. So there’s a, you know, a lot of different thoughts as to what may be at play there and what the specific causative agent is. But you know, hands down, just trying to get away from smoking and tobacco use is a big thing here.
Bruce Kassover: That’s remarkable. And Dr. Gill, I really, I thank you for your perspective. I think that this is incredibly important information that could genuinely be lifesaving. So I really thank you for sharing all of this insight and we hope that people pay attention to what you have to say and do something good and seek out help as soon as necessary.
Dr. Gill: Glad to help. Thanks for having me.
Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at nafc.org.
To learn more about the National Association for Continence, click here, and be sure to follow us on Facebook, Instagram, Twitter and Pinterest.
Music: Rainbows Kevin MacLeod (incompetech.com)
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