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  • #44485
    Antun
    Participant

    Does anyone know whether you can do a test – other than a cystoscopy test – to examine your bladder? Is there a blood test or a ctDNA test (circulating tumor DNA)that can show results?

    What is the best way to get ready for a cystoscopy?

    Would it be a good idea to change Urologist if you think yours is not doing a good job?

    Does anyone know whether a cystoscopy procedure – if done incorrectly – can cause Peyronie’s Disease?

    #44487
    marysue
    Participant

    Hi Antun:

    As mentioned in my other post, a cysto is usually the best way to exam the inside of your bladder to see what is going on.  X-rays and ultrasound can reveal tumours if they are large enough as that is what happened with me on my first go round with bladder cancer.  I have no idea about a circulating ctDNA test.  That would be something to ask your doctor.

    There is no special preparation for a cystoscopy. You can eat, drink, take any meds right up until the exam and go back to your normal daily routine post exam. They do give you a local freezing in the urethra which helps the scope go in.  The exam only takes a few minutes.  Female patients are sometimes asked to change into a gown depending on hospital/clinic policy.  I bring my own long dressing gown as I hate the short hospital gowns.  I’m very tall so they are often like mini dresses on me. I’ve never had an issue from staff about this.

    However, I do take a shower before going to the clinic.  Being female,  I make sure that my “area” is extra clean in an attempt to avoid a potential UTI.  I also take a strong cranberry pill and drink lots of cranberry juice about a week prior to the exam along with extra water to hydrate my body well and also continue this for about a week post exam.  This is not on the recommendation of any of my doctors.  It is just a personal preparation preference.  I base it on something my childhood urologist told me about my kidneys.  I was born with urological birth defects of a very narrow urethra and a kinked up, narrowed left ureter.  This was back in 1965 when surgeries were a hell of a lot more invasive than they are today.  It took 3 surgeries to make the situation right and post op my kidneys were a little slow coming out of the anesthetic so my uro told me (at age 7) that I had to make them work and the best way to do that was to drink a lot of water and other liquids.  I have done that ever since after every surgery and every cysto.  I also remind any surgeons and anethesiologists of this as well when I’m having surgery. I normally drink at least 2 liters of water daily anyhow.

    If you are uncomfortable with your current urologist for any reason, you are within your rights to seek out care from another one.  My first uro was an excellent surgeon but his bedside manner left a lot to be desired.  He didn’t treat me with any great measure of respect so I contacted the head of urology and asked for a referral to someone else.  I like the guy I have now and plan to stick with him.

    As for Peyronie’s disease, I can’t answer that as I haven’t heard of this disease before.  It would be a good question to ask your doctor.  Best Wishes.  (((HUGS)))

    #44517
    Joe
    Participant

    Hi ARTUN,

    I can comment on non invasive diagnostic methods for bladder cancer, which are urine analysis and blood analysis such as ctDNA.

    Urine analysis which are being used in NA are cytology, UroVysion (FISH technology), CxBladder.  In Canada, only cytology is available, but I will explain other two methods also.  It assumes that cancer cells fall off from bladder call into urine.

    All three are being used as complement to cystoscopy.   I have noticed the frequency in use of cytology depends upon urologist.

    In cytology, cytopathologist – pathologist who specializes in urine analysis examines urine sample with a microscope just like histopathologist examines at tissue sample with a microscope.  Cytology was known to be rather in accurate especially diagnosing low grade and 30% of diagnosis was reported as Atypical.  So, in 2013, at the international cytopathologist conference in Paris, they published The Paris System (TPS) for reporting cytology. They have decided that cytology for bladder cancer is to focus on detecting high risk bladder cancer, i.e. HG and CIS as they can be life threatening unless treated vs LG may have high frequency of recurrence but not life threatening as they do not progress to HG with exception.   TPS  reduced Atypical to 8%.  Under TPS,  “Negative for High grade Urothelial Carcinoma” (HG UC) means no HG/CIS  with 90+% accuracy.  “Suspicious for High Grade UC” means HG/CIS with 50-90% accuracy.   “High grade UC” means HG/CIS with 90%+ accuracy.    Because in cytology, pathologist looks at cells vs in cystoscopy urologist only can examine at tumor level, some urologist uses cytology after cystoscopy for surveillance of high risk NMIBC when cystoscopy is negative.  If cytology is Negative for high grade UC”, then urologist is assured that the patient is clear, but if cytology says Suspicious for High Grade UC or High Grade UC, the urologist will have to search more.

    UroVysion FISH finds out if there are more than a pair in Chromosome 3, 7, and 17 and if a section of Chromosome 19 is missing.  A chromosome contains DNA.  Cancer is caused by mutation of multiple genes in DNA.  We have 23 pairs of chromosomes.  It is known that abnormal numbers of Chromosome in 3,7, 17 are associated with bladder cancer and also missing of a specific section of chromosome 19 is also associated with bladder cancer.  UroVysion  FISH puts florescence material with different color  to a centre of Chromosome 3,7, and 17 at DNA level, and the specific section of  DNA of chromosome 19.   So, a  technician can count number of chromosomes.   Then, pathologist at the lab who analyze urine using UroVysion FISH will review and report if the result is Positive for bladder cancer or Negative for bladder cancer.

    CxBladder is rather new method based upon analyzing 5 different biomarkers at messenger RNA level.  Note that DNA contains 20-30,000 coding genes, with which our body makes 20-30,000 different proteins.  When DNA contains mutated genes, our body makes proteins which do not function as it is supposed to.  For example, we have a gene called FGFR gene- Fibroblast Growth Factor Receptor. FGFR protein receives a signal from our body to start a cell division cycle when our body thinks it is time for the cell to die and be replaced wit two new cells. When FGFR gene is mutated, the protein FGFR starts cell cycle without waiting the signal from our body.  One of hall marks of cancer is its ability to grow faster than normal cell by constantly producing new cells.  So, the mutation of FGFR has strong association with bladder cancer.  60% of low grade bladder cancer has mutation in FGFR genes.   We use FGFR genes mutation as test to qualify for the drug treatment – Balversa (Erdafitinib) for advanced bladder caner.   CxBladder checks 5 different genes which are known to be associated with bladder cancer.   MDK : Blood vessel growth and cell migration,  HOXALA13 : Cell differentiation,  CDC2: Cell division,  IGFBP5: Programmed death, and CXCR2: Inflammation.   CxBladder uses its propriety method  to analyze those 5 different genes and report the probability of bladder cancer.

    When the Covid Pandemic started.  In the US,  bed room became scares just like Canada, especially  operating rooms.  Cystoscopies were delayed and TURBT were delayed.  So, some hospital like University of Southern California used CxBladder instead of Cystoscopy.   CxBladder claims they can better predict also low grade tumor (90%+ accuracy) by adding patient’s age, sex, smoking habit, etc..

    I recall in our discussion forum, a patient in the US, relied on all three urine analysis test as his urethra was narrow so they could not use regular cystoscopy until they decided to use ureteroscope which is much narrower than regular cystoscope.

    ctDNA – circulating tumor DNA analysis using blood sample

    It assumes that when cancer cell die, its fragment of DNA will get into blood stream and circulate in blood.

    Dr. Alexander Wyatt team in Prostate Centre in BC is one of front runners in Canada in ctDNA research in both prostate cancer and bladder cancer.   As matter of fact,  BCC sponsored ctDNA early research for bladder cancer.   10 years ago, applying ctDNA was cost inhibitive for regular diagnosis, but technology for DNA sequencing analysis has improved and the cost of DNA sequencing analysis has also dramatically dropped.  I attended a webinar by a post doc of Dr. Whyatt’s lab a few years ago.  I already forgot the detail of the webinar but it was about application of ctDNA for advanced bladder cancer. But, I do not think ctDNA has passed research stage yet so it is used like urine analysis.

    A 2021 study published on ctDNA application to predict recurrence of non muscle invasive bladder cancer says the detection rate of Ta stage was 52.08%.   Cystoscopy is much more accurate detecting TaLG tumors than ctDNA at this point.  Below is the link to the study.

    https://www.frontiersin.org/articles/10.3389/fonc.2021.657483/full”

     

    Peyronie’s disease by cystoscopy

    I saw a rare case study that swabbing penis resulted Peyronie’s disease. Cystoscopy in invasive and  can cause trauma to urethral in some cases, so it is possible that some patients could have developed Peyronie disease as it is associated with scared tissue by trauma to urethral.  But it must be very rare.  I read many research papers, but it is also the first time I have heard of peyronie’s disease.  Thank you for posting.  We always can learn from each others.

     

     

    #44714
    Antun
    Participant

    Thank you so much Joe. Your analysis will help me to try and get cytology test.

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