After encountering treatment options “that scared me to death,” NFL Hall of Famer Deion Sanders anticipates a full recovery from bladder cancer and returning to the sidelines as head coach of the University of Colorado Buffaloes.
Like so many cancers, his was discovered during routine follow-up; in his case, for a previous bout of blood clots in his legs. At a press conference in Boulder, Sanders spoke about his own journey through cancer and encouraged others to “get yourself checked out.”
“Especially African American men. We don’t like going to doctors,” said Sanders. “We don’t like nothing to do with a doctor. We know that. [But] I’m not just talking to the brothers, I’m talking to my Caucasian brothers, my Hispanic brothers, my Asian brothers, my everybody, and my sisters. All y’all get checked out, because it could have been a whole ‘nother gathering.”
Sanders was joined by urologic surgeon Janet Kukreja, MD, of the UC Health Grampsas Urologic Cancer Care Clinic in Aurora, Colorado. She described the cancer as “high grade, invading into the bladder wall but not into the muscle layer, something we call very high-risk non-muscle-invasive bladder cancer [NMIBC].”
After discussing all the treatment options, “we elected to undergo bladder removal,” Kukreja continued. “We performed a full robot-assisted laparoscopic bladder removal and creation of a new bladder. I am pleased to report that the results from the surgery are that he is cured from the cancer.”
Promising “full transparency” to the press in attendance, the 57-year-old Sanders acknowledged that the neobladder is not the same as the original.
“I’m still dealing with going to the bathroom,” he said. “I can’t pee like I used to pee. It’s totally different.”
Urologic oncologists who spoke with MedPage Today agreed that Kukreja’s description of the cancer suggested a high-risk NMIBC.
“The options for non-high-risk, non-muscle-invasive bladder cancer include intravesical therapy, but in patients with very high-risk features, cystectomy can be preferred,” said Matthew Milowsky, MD, of the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina. “My sense is there were high-risk features, probably several, such as involvement of the prostatic urethra or lymphovascular invasion.”
Fortunately, non-metastatic bladder cancer has a high cure rate, “but requires care from a skilled team of doctors in order to get the best chance at cure,” said Elizabeth Plimack, MD, of Fox Chase Cancer Center in Philadelphia.
Neither Sanders nor Kukreja mentioned a specific timeline from diagnosis to surgery. The typical time to recovery of most activities after cystectomy is 4 to 6 weeks, said Jodi Maranchie, MD, of the University of Pittsburgh Medical Center.
“It sounds like he was already standing for the press conference, so I suspect he’s already back on his feet,” she said.
Follow-up, presumably with a urologic oncologist, usually includes imaging studies at 6-month intervals for a year, and then extended intervals thereafter in the absence of recurrence or complications.
“We also follow with urine cytology to make sure there’s no recurrence in the urethra or in the ureters or in the renal pelvis,” said Maranchie.
Sanders’ observation about urination is typical of the patient experience with a neobladder.
“A neobladder does not contract like a native bladder; instead, patients must learn to void by relaxing the pelvic floor and applying abdominal pressure,” said Alexander Kutikov, MD, also of Fox Chase Cancer Center. “Early on, many patients experience urinary leakage, especially at night. Pelvic floor exercises are important to improve continence.”
“While many regain daytime continence, up to 20% of patients may continue to leak at night due to loss of the reflex that tightens the sphincter during sleep,” he explained. “On the other hand, about 10-15% of patients may have trouble emptying the neobladder and need to use a catheter. A neobladder can restore independence and good quality of life, but it does take time, training, and adaptation.”
Neobladder is not for every patient, said Milowsky. Some prefer an ileal conduit and find that “the bag” eliminates some of the worry and nuisance involved with learning to live with a neobladder, including the potential need for catheterization.
Because radical cystectomy involves removal of the prostate, the procedure carries a risk of sexual dysfunction. Men with intact sexual function before surgery have a two-thirds chance of regaining sexual function after a nerve-sparing prostatectomy, said Maranchie. Two thirds of the remaining patients have at least some degree of recovery with medication.
“I think his likelihood of recovery is high,” she said.
As Sanders acknowledged, early detection and diagnosis, though incidental in his case, made all the difference with respect to hopes for living a full and productive life.
“The goal is cure and the chances are best if bladder cancer is caught early,” said Plimack.
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