Retired Police Officer Now Cancer Free After Surgery, Bladder Cancer Clinical Trial 

When Greg learned that he had bladder cancer, he wasn’t necessarily surprised.

“It wasn’t a shock, and I didn’t think, ‘why me,’” he says. “I started smoking at a very young age and smoked for 27 years. I just thought it would be my lungs, not my bladder.”

The 71-year-old retired police officer isn’t alone, says Shreyas Joshi, MD, a urologic oncologist with Winship Cancer Institute of Emory University.

“Smoking is a big risk factor for bladder cancer that many people don't know about,” Dr. Joshi says.

Smoking may be the leading bladder cancer risk factor, but it isn’t the only one.

Bladder cancer, sometimes called urothelial carcinoma or transitional cell carcinoma, is more common in men than women. The American Cancer Society estimates there are about 85,000 new cases of bladder cancer in the U.S. each year. More than 65,000 of those are men.

Your chances of developing bladder cancer are higher if you are exposed to certain industrial chemicals or take certain medications or herbal supplements. Other risk factors include:

• Age (bladder cancer rates are higher in people over age 55)
• Being born with a bladder defect or issue
• Certain genetic conditions like retinoblastoma (eye cancer)
• Personal or family history of bladder or other urothelial cancers
• Race and ethnicity (white people have higher bladder cancer rates compared with African American and Hispanic people)

Bladder cancer begins when cells in the inner lining of the bladder—the urothelium—grow abnormally. Symptoms include painful or frequent urination and low back pain.

Greg’s experience with bladder cancer started with another warning sign.

“I noticed some blood in my urine and said, 'That’s not good.’ I went right to my Emory primary care provider Shonda Waddell, PA,” Greg says.

Blood in your urine, also called hematuria, is the most common bladder cancer symptom. Sometimes, it’s visible to the eye. Other times, it’s microscopic.

“Most people discover bladder cancer after seeing blood in their urine,” Dr. Joshi says. “That should always prompt an evaluation—especially for people who are older, male or have a history of smoking.”

For women, bladder cancer is often caught later when it’s harder to treat. Dr. Joshi says this may be due to mistakenly linking early signs—like blood in the urine—to urinary tract infections. He encourages everyone, especially women, to ask for further testing if something feels off.

Diagnosing Bladder Cancer

Urologists diagnose bladder cancer using a combination of urine tests, imaging (like CT scans) and cystoscopy. This procedure uses a lighted camera to examine the inside of the bladder.

“At Winship, we have special technologies to diagnose and treat bladder cancer, including blue light cystoscopy,” Dr. Joshi added. “It helps us detect lesions that might not be visible under regular light. It’s another tool that can help catch bladder cancer early, when it's more treatable.”

Greg didn’t necessarily need further diagnostic testing after seeing the urologist in the community. But he did seek a second opinion at Winship Cancer Institute after his initial diagnosis.

"Always get a second opinion,” is a life motto for Greg. He says, “Anything serious coming your way—your health, your finances, your love life—get help."

And he’s glad he did.

“It was clear to me that these fellas were bringing their A-game,” Greg says.

By “fellas,” Greg means Dr. Joshi and medical oncologist Mehmet Bilen, MD.

"Dr. Bilen looked me in the eye and said, 'I’m going to cure your cancer.' There was no doubt in his mind,” Greg says. “That’s when I realized I needed to bring my A-game, too, so I began a more rigorous exercise routine prior to chemo and surgery.”

To determine the best treatment for Greg, Dr. Joshi and Dr. Bilen held a multidisciplinary tumor board meeting with other members of Winship’s bladder cancer team. There, urologists, oncologists, radiologists and pathologists reviewed Greg’s case.

Tumor boards are a common practice in cancer care at Winship. During these meetings, specialists work together to design treatment plans tailored to each patient’s needs, risks and preferences.

Bladder cancer treatment options vary based on when the cancer is detected and how far it’s spread. Earlier cancers may just need to be removed and treated with medications. Later-stage and more aggressive cancers often benefit from stronger cancer-fighting drugs and more invasive surgeries, including bladder removal.

Greg had muscle-invasive bladder cancer. That means it had left the urothelium and traveled into the bladder muscle. And that detail made a big difference.

“Once bladder cancer is muscle-invasive, we treat it more aggressively,” Dr. Bilen says. “Even if imaging doesn’t show spread, there’s still a risk of micrometastases—tiny cancer cells traveling through the bloodstream.”

Greg’s treatment would include surgery to remove his bladder (cystectomy) and create a new bladder (neobladder) from a portion of his intestine.

Dr. Joshi, who performed Greg’s surgery, says this option can provide better long-term quality of life for carefully selected candidates.

Before surgery, however, Greg needed chemotherapy to shrink his tumor. But there was a catch: The common pre-surgery chemotherapy used for bladder cancer, cisplatin, is known to cause or worsen hearing loss.

Greg, a former Army helicopter pilot, says, “I told Dr. Bilen, ‘My hearing’s already bad. I can’t afford to lose what’s left.”

Fortunately, Winship focuses on advancing bladder cancer research, and the team was enrolling patients in a clinical trial for a newer drug called enfortumab vedotin (EV). EV was already approved for metastatic bladder cancer but was being tested for earlier-stage use. Greg felt hopeful and agreed to participate.

“He’s a brave guy,” Dr. Bilen recalls. “Enrolling in a clinical trial takes courage—not just for your own sake, but to help others down the line.”

Greg responded well to the treatment, and even better news came after surgery. His pathology report showed no residual cancer.

“That’s the best possible outcome,” Dr. Bilen says. “A complete pathological response means low risk of recurrence.”

For Greg, recovery hasn’t been free of challenges. A neobladder doesn’t give you the same physical warnings when it’s time to go to the bathroom. And urinary tract infections are common.

Still, five years after his diagnosis, Greg remains cancer-free.

"So many things fell into place for me. Not because I went into denial or got angry, but because I faced it,” Greg says. “I'm deeply grateful for everything that's happened along this route. Considering the news, I feel blessed."

Bladder cancer treatment is constantly changing. And, while surgery was Greg’s best option, sparing people from bladder removal is the ultimate treatment goal.

New options like immunotherapy, targeted therapy and gene therapy are particularly important for people who may not tolerate traditional chemotherapy or surgery.

At Winship, gene therapies are already helping patients avoid surgery. For those with advanced or recurrent disease, combining chemotherapy and immunotherapy is showing encouraging results.

Dr. Joshi says another innovation on the horizon is circulating tumor DNA (ctDNA), a type of “liquid biopsy” that can detect cancer DNA in a simple blood sample. This could revolutionize early detection, treatment response monitoring and recurrence surveillance, not only for bladder cancer, but for other cancer types as well.

“The past five years for bladder cancer have been extremely exciting because we are starting to get new therapies that we never had in the past,” Dr. Joshi says. “That's hope that we never had before, and Winship is really at the cutting edge of being able to deliver it.”