Urologist at UC San Diego Health, Amirali Salmasi, MD talks about a new technique to detect bladder cancer.
Interview conducted by Ivanhoe Broadcast News in 2023.
A lot of cancers, I have seen, rises. Has there been a rise in bladder cancer as well?
Salmasi: Yes. Actually, new data shows that the incidence of the bladder cancer is increasing every year.
Is there a reason behind that?
Salmasi: No, not really. We don’t know why is the incidence is going up, no.
And how is it normally detected?
Salmasi: So people usually with the most common- the symptoms they have is a little bit blood in the urine. It can be from the microscopic blood or gross blood or they can have some irritative symptoms like urgency, frequency, pain with urination. And then when we see these people, they usually we ask for a risk factor. They usually have some risk factor like smoking contacts with some chemicals. And based on that, we screen the people and then we offer them the appropriate diagnostic tools.
Are there specific chemicals that are more associated with bladder cancer?
Salmasi: Usually, we call a paint, contact with the pain, some type of plastic, some drugs, they can cause bladder cancer.
So is it a lot like prostate cancer? The doctors do biopsies but it’s like a shot in the dark. You put the biopsy needle in there and you come back out and you could miss it, you could get it. Is it bladder cancer a lot like that?
Salmasi: It’s yes and no. It’s very different from the prostate biopsy because when we do the prostate biopsy, we put the ultrasound probe in the rectum, we just see the prostate, we don’t see the lesion. But for bladder, when we put the camera in the bladder, we see the lesion. But the question comes here, sometimes there’s some inflammatory changes and they are not cancerous or sometimes the area is so small and subtle that could be missed. Not every the bladder looks healthy, clean, that we go there, this is lesion, we need to do the biopsy. And that’s the reason that sometimes the biopsies comes negative sometimes it could be missed, a lesion in the bladder.
But now we have a blue light that helps you see it a little bit better?
Salmasi: Sure. When we use the cystoscopy with the white light, white light just looks like if we see any lesion or not. With the blue light, you use the drug called 5-Aminolevulinic acid that goes into the tumor cells and the normal cells and the precursor of the porphyrin. The porphyrin has increased fluorescence under blue light. When we use it with blue light, the cancer cells accumulate these drugs and they have a fluorescence. By doing that, we can have some contrast between the tumor cells and the normal cells. By doing that, increased our detection rate.
Do you have specific numbers, like how much more you can see?
Salmasi: So for bladder cancer, we have two types of usually bladder cancer. One is a papillary or a cecile, that is something visible and we have a one sort as aggressive but non invasive is flat, we call carcinoma in situ. Our problem is that CIS or carcinoma in situ, because they are already flat and it’s not easy to see that, that’s the most useful part of the blue light is diagnostic. Aggressive flat cancer,. If you ask me the number, there is some good data that shows that in 11% of the people, they can change your diagnosis or upgrade your diagnosis. Any study has a different results. There’s multiple that. This is the number I think that came with the larger study. But again, there are multiple numbers there for years and years That shows that increased detection rate, decrease the progression, decrease the recurrence of the bladder tremors.
So do you use this now for every patient that is diagnosed with bladder cancer or you think?
Salmasi: We have it in the clinic, and then there’s a place you can use it in clinic or in the operating room. We have both, I use it both. I feel like the usefulness of this technology is a surveillance of the people already have a high risk disease. For all commerce, it might be over use it if someone thinks about the cost and all this thing, it might not be that helpful because most of the time the cystoscopy is going to end up negative or we cannot find. But for people with a high risk disease, especially after treatment, is the blood is not going to be that clean and I think that’s the most usefulness of this technology.
How long have you been doing this?
Salmasi: In the clinic, we have it for more than a year. But for the operating room, I have done it for more than two years.
When you first did it, did it amaze you? How many bladder cancer patients have you helped throughout your career?
Salmasi: It’s hard to say. But, I’m not going to say in the day by day I find someone that helps me. Again, I do a lot of cystoscopy. Maybe it’s different in my hands from someone that his eyes or not familiar and just a day by day, but once in a while that I’ve seen people say, wow, this is completely normal. And there is one red spot shows on the blue light and the biopsy and then it shows like there’s carcinoma in situ.
And just being able to catch that at that stage where there’s nothing to see, that has to be life saving, right?
Salmasi: So it’s very important because when we find this people on this stage, we can offer them the treatment or aggressive treatment. When they have a high risk, especially in the carcinoma in situ, they have a very high risk of the progression, despite they are very flat and superficial. So missing that and in the three months or six months we’re going to find it is going to show itself, might be late that time, and from the treatment could be spread by that time.
Are there other cancers that this would help in, other than bladder cancer?
Salmasi: I’m not aware of it.
END OF INTERVIEW
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Annie Pierce Michelle Brubaker
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