Ep. 310 Bladder Cancer Risk Stratification: Best Practices with Dr. Sunil Patel and Dr. Kristen Scarpato

Why does up to 10% of bladder cancer pathology change on expert review, and what does that mean for your intermediate and high-risk patients? In this episode of BackTable, Dr. Bogdana Schmidt interviews urologists Dr. Kristen Scarpato and Dr. Sunil Patel to explore the complexities of diagnosis and risk assessment in non–muscle invasive bladder cancer (NMIBC). They discuss the real-world challenges of pathology interpretation, risk-group assignment, evolving diagnostic tools, and the impact these factors have on treatment decisions and patient outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps00:00 - Introduction01:02 - Risk Stratification07:22 - Upstaging to High Risk10:06 - Calculators and Patient Education15:22 - Specific Tests Use Cases18:50 - Conflicting Biomarker Results21:36 - Adjunct Tests and Counseling24:03 - Recurrence After Chemo Next Steps27:01 - Escalation Deescalation Balance32:48 - Future Research Priorities35:43 - Biology Based Risk Stratification38:03 - Clinical Pearls and Wrap Up --- More about this episodeThe conversation highlights the heterogeneity of intermediate-risk disease, the role and importance of expert pathology over-reads, and the need to accurately document the risk category for ongoing care. They discuss selective use of urinary and genomic assays and how these tests fit alongside cystoscopy and blue light endoscopy. Practical treatment approaches are reviewed, including when to use intravesical gemcitabine or BCG, managing care during BCG shortages, and balancing escalation versus de-escalation of therapy. Additional topics include strategies for long-term surveillance, upper tract imaging, rising rates of bladder cancer in younger patients, and why thorough TURBT and strong patient-provider communication remain central to optimal management. --- Resources The Memorial Studyhttps://www.mskcc.org/cancer-care/clinical-trials/19-288 The BRIDGE Studyhttps://www.nejm.org/doi/full/10.1056/NEJMoa1501035 --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app