Bladder Pathway

Bladder cancer is one of the most common malignancies and, if not diagnosed and treated early, can lead to unnecessary or delayed surgical interventions, increasing risks for the patient. For this reason, it is essential to adopt a multidisciplinary and personalized approach, allowing all therapeutic options to be evaluated before resorting to cystectomy.

Advanced Diagnosis of Bladder Cancer

Thanks to Prof. Porreca’s expertise at Humanitas Gavazzeni, the Bladder Pathway employs the most advanced technologies for the early diagnosis of bladder cancer, including:

  • Advanced endoscopy with Narrow Band Imaging (NBI): improved lesion detection compared to standard cystoscopy.
  • Photodynamic Diagnosis (PDD) with Hexvix® – A technique that uses sodium hexaminolevulinate (Hexvix®), a fluorescent contrast agent, to detect superficial bladder tumors with greater sensitivity, especially those not visible with standard cystoscopy.
  • Targeted biopsy and TURBT: essential for tumor staging and therapy planning.

The use of Hexvix® in the diagnosis of bladder cancer represents a significant advancement, as it allows for:

✔ Easier identification of non-muscle-invasive tumors (NMIBC).

✔ Improved accuracy of tumor resection, reducing recurrence risk.

✔ Guides therapy and surveillance, increasing effectiveness of intravesical treatments.

Endovesical Therapies to Preserve the Bladder

For patients with non-invasive bladder tumors, treatment may include advanced intravesical therapies aimed at reducing the risk of progression and recurrence, while avoiding bladder removal whenever possible.

✔ BCG (Bacillus Calmette–Guérin): Intravesical immunotherapy considered the gold standard for the treatment of high-risk urothelial carcinoma stimulating the immune system to destroy cancer cells

✔Mitomycin C: intravesical chemotherapy for intermediate-risk tumors.

✔ EMDA®: (Electromotive Drug Administration)  Groundbreaking technique that improves intravesical drug absorption via low-voltage electrical current, enhancing mitomycin efficacy.

The integration of these therapies into the Bladder Pathway helps maximize the chances of bladder preservation and reduces the need for radical cystectomy.

Ongoing experimental clinical studies at the Urology Department of Humanitas Gavazzeni Bergamo, led by Prof. Porreca

At the Urology Department of Humanitas Gavazzeni Bergamo, several experimental clinical studies are currently underway, aimed at offering new therapeutic perspectives for patients with bladder cancer.

  • MoonRISE-1 involves the use of the TAR-210 delivery system, an experimental intravesical delivery system designed to administer Erdafitinib, a selective FGFR (Fibroblast Growth Factor Receptor) tyrosine kinase inhibitor, directly into the bladder in a controlled manner. It consists of a small flexible tube inserted into the bladder via a catheter by healthcare personnel, releasing the drug gradually over approximately 12 weeks, thereby reducing systemic exposure and potential side effects.
  • ONCOFID-P-B is an experimental therapy that combines Paclitaxel and Hyaluronic Acid, administered intravesically like BCG, with the aim of enhancing its antitumor efficacy.
  • Hydeal Cyst is aimed at patients with non–muscle-invasive bladder cancer and evaluates the effectiveness of an additional intravesical instillation based on hyaluronic acid and Hydeal-D to reduce local irritative symptoms associated with adjuvant therapies with Mitomycin C or BCG.

When Robotic Cystectomy is Needed

If conservative therapies fail or in the case of muscle-invasive tumors, cystectomy is the treatment of choice.
The Bladder Unit carefully evaluates each individual case to offer the best possible treatment, minimizing the impact of surgery on the patient’s quality of life.
The decision to perform the surgery is always made within the context of a multidisciplinary discussion, evaluating the best options to ensure optimal therapeutic efficacy and the patient’s quality of life.
Robotic surgery allows less invasive treatment, faster recovery, and better functional outcomes.

Conclusions

The Bladder Pathway, developed by Prof. Angelo Porreca, offers a comprehensive and personalized approach for the diagnosis and treatment of bladder cancer.

Primary goal: to preserve the bladder whenever possible, thanks to advanced diagnostic technologies (NBI, PDD with Hexvix®), innovative intravesical therapies (BCG, Mitomycin, EMDA), and careful patient monitoring.

When necessary, robotic cystectomy represents the most advanced surgical option, ensuring less invasiveness, reduced complications, and improved post-operative quality of life, especially for patients eligible for neobladder reconstruction.

Thanks to the experience gained in the Bladder Unit, patients can rely on a highly specialized team and state-of-the-art technologies to navigate the treatment pathway with the highest level of safety and effectiveness.