Positive Prospects

In 2020, Michael Heller had been taking antibiotics for a urinary tract infection, but blood in his urine and abdominal pain landed him in the Emergency Department at Froedtert West Bend Hospital, part of the Froedtert & the Medical College of Wisconsin health network. A CT scan revealed bladder wall thickening, a potential sign of cancer. The subsequent biopsy led to a diagnosis of stage IIA, high-grade, muscle-invasive bladder cancer with lymph node involvement.

“I was surprised,” Michael said. “But I kept a positive attitude.”

Bladder cancer is the fourth most common cancer in men, according to the American Cancer Society. About 82,300 new cases of bladder cancer — predominantly in men — will be diagnosed this year. When caught early, doctors can often surgically remove tumors and deliver drugs into the bladder to fight residual cancer. In advanced cases like Michael’s, however, treatment can be more complex and includes bladder and prostate gland removal. Those are the treatments Michael, now 72, pursued. 

At the Cancer Center at Froedtert West Bend Hospital, he was treated by experts including Colin Mooney, MD, medical oncologist, and Peter Langenstroer, MD, MS, urologic oncologist and MCW faculty member. 

Michael initially had 12 weeks of chemotherapy, followed by a radical cystoprostatectomy, a surgery to remove the bladder and the prostate gland. The surgery also included construction of an ileal conduit, where surgeons use a section of the small intestine to create a path for urine to drain from the kidneys to a permanent stoma — an opening in the abdomen.

The surgery is not without potential complications, as Michael discovered during his recovery period. He developed bowel problems, complicated by inflammation in the back of his abdominal cavity — issues that led to a hospital stay on his birthday. Dr. Langenstroer tried to make it better by delivering Culver’s frozen custard. It also meant Michael had more time to learn about taking care of his stoma and working with the nurses he came to adore. 

“The care was super,” Michael said. “They were the best nurses I ever had.”

Complex Treatment

A bladder cancer diagnosis and treatment options can be difficult for patients to accept. 

“Depending on each unique situation, we can treat patients with chemotherapy and surgery,” Dr. Langenstroer said. “Advanced cases with muscle involvement almost always require bladder removal, unless the patient isn’t healthy enough to withstand the operation. Some patients are reluctant to have surgery and want to explore alternatives such as radiation therapy. Others want to get the cancer removed as soon as possible and are willing to part with their bladders if that’s what it takes.”

Typical treatment for advanced bladder cancer spans several months. After chemotherapy, patients prepare for the surgical procedure. Their general health is assessed to confirm that they will be able to withstand the stresses of the surgery. A stoma nurse meets with the patient to determine the best placement for the stoma. A dietitian educates the patient about nutrition before and after the surgery. Patients also visit the surgeons who will perform the surgery, including the surgeon who removes the bladder and prostate gland and the surgeon who constructs the ileal conduit.

“This two-pronged approach is different from what patients may encounter at other health systems,” Dr. Langenstroer said. “There aren’t a lot of situations where we use two different surgeons during an operation, but we prefer to split up the six- to eight-hour procedure. The patient gets a fresh set of expert hands for the second part of the surgery.”

Bladder Cancer Survival Rate

The survival rate for bladder cancer varies by the extent of the cancer’s spread at diagnosis. For local or superficial bladder cancer, 70%-96% of patients experience a five-year survival rate, while survival rates for patients with regional or distant spread vary from 8%-39%. 

But, doctors feel good about Michael’s prospects.

“Most advanced bladder cancer recurrences come back one to two years after the initial surgery,” Dr. Mooney said. “Michael has moved past this window and is now having annual scans to check for recurrence.”

Regardless of the cancer’s stage and the extent of its spread, every patient treated within our Cancer Network is given the care and dignity they deserve. 

“Our team of nurses helps educate patients about how to live life without a bladder,” Dr. Mooney said. “I think people do much better than they ever expected.”