This content is available free to the GRU Community. Login or create an account to view it.
How to cite: Bochner BH. Session 1 Panel Discussion: Pathology, Etiology, and Diagnosis of Urothelial Cancer. Grand Rounds in Urology. December 2025. Accessed Apr 2026. https://grandroundsinurology.com/session-1-panel-discussion-pathology-etiology-and-diagnosis-of-urothelial-cancer/
Summary
A multidisciplinary panel examines the practical implementation of enhanced cystoscopy, the evolving management of carcinoma in situ, and the potential role of artificial intelligence in improving diagnostic precision and clinical trial interpretation.
The panel focuses on real-world adoption of blue light cystoscopy and narrow band imaging in the surveillance and management of non–muscle-invasive bladder cancer. Participants describe variability in practice patterns driven by workflow constraints, cost, equipment availability, and scope platform limitations. Blue light cystoscopy requires pre-procedure intravesical instillation and scheduling adjustments, limiting spontaneous use in busy clinics. Narrow band imaging is easier to toggle during standard cystoscopy, but it is not universally available, particularly as disposable scopes become more common.
Operational challenges, maintenance contracts, and discontinuation of certain flexible blue light platforms further restrict access. Despite these barriers, participants emphasize that enhanced imaging technologies improve visualization of small papillary tumors and carcinoma in situ. The debate centers on whether enhanced cystoscopy should be mandated in clinical trials to standardize detection and reduce variability in the quality of transurethral resection of bladder tumors.
A major theme involves carcinoma in situ heterogeneity. Small focal lesions detected with enhanced imaging may biologically differ from extensive multifocal disease, yet both are categorized similarly in single-arm trials. The panel questions assumptions that all carcinoma in situ represents persistent disease after resection, noting that aggressive resection and fulguration may eliminate visible disease in a subset of patients. Lack of objective quantification methods complicates the assessment of response and the interpretation of therapeutic efficacy.
Participants discuss limitations in histologic sampling of carcinoma in situ and challenges in molecular analysis due to minimal tissue volume. Urinary-based assays and circulating tumor DNA are suggested as potential objective tools. Artificial intelligence–based cystoscopic enhancement, image capture, and three-dimensional mapping may enable quantification of lesion surface area and improve longitudinal assessment of response.
The discussion highlights the need for standardization, objective measurement, and integration of emerging technologies in both clinical practice and trial design.
About the 2025 International Bladder Cancer Update Expert Forum™
ABOUT THE AUTHOR
Yair Lotan, MD, is a Professor of Urology, Chief of Urologic Oncology, and holder of the Jane and John Justin Distinguished Chair in Urology, in Honor of Claus G. Roehrborn, MD at University of Texas Southwestern Medical Center. He is also the Medical Director of the Urology Clinic at UT Southwestern and Parkland Health and Hospital System. Dr. Lotan is known nationally for his research on urine markers and molecular markers, which help determine which patients are at higher risk for recurrent cancer.
Donna E. Hansel, MD, PhD, is currently the Division Head of Pathology and Laboratory Medicine at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr. Hansel’s lab focuses on identifying high-yield, targetable pathways in advanced bladder cancer, with a strong emphasis on mTOR signaling and novel downstream targets that are involved in cell motility and invasion.
Nima Almassi, MD, is a Urologic Oncologist at the Glickman Urological & Kidney Institute at the Cleveland Clinic in Ohio. Dr. Almassi’s research interests include investigating how body composition impacts the efficacy and tolerability of multimodal treatment of bladder cancer, outcomes of bladder-sparing therapies in patients with bladder cancer variant histology, and the optimization of quality-of-life outcomes for patients undergoing treatment for genitourinary malignancies.
Bernard H. Bochner, MD, FACS, is the Sir Murray F. Brennan Chair in Surgery and a Professor in the Department of Urology at Memorial Sloan Kettering Cancer Center in New York, New York. Dr. Bochner’s main areas of expertise include radical surgical procedures for invasive bladder cancer and reconstructive surgery of the urinary system following radical cystectomy or pelvic exenteration.
Daniel P. Petrylak, MD, is a Professor of Medicine, specializing in Medical Oncology and Urology, and Chief of Genitourinary Oncology at Yale University Cancer Center in New Haven, Connecticut. Dr. Petrylak is an internationally renowned medical oncologist and is considered a pioneer in the research and development of new drugs and treatments to fight cancers of the prostate, bladder, and kidney.
