Ep. 323 Managing Intermediate-Risk Bladder Cancer with Dr. Charles Peyton

Recurrent low-grade, intermediate-risk bladder cancer presents a unique treatment challenge: recurrence is common, progression is uncommon, and the burden of repeated procedures can add up quickly. On this episode of the BackTable Urology Podcast, Dr. Ruchika Talwar interviews Dr. Charles “Chas” Peyton about how to manage intermediate-risk bladder cancer patients while balancing disease control and quality of life. They discuss the cumulative impact of repeated TURBTs and explore the evolving role of office-based treatments and chemoablative therapies as alternatives to the traditional treatment cycle. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 05:58 - Comparing Office Ablation and OR TURBT 08:26 - TURBT Impact on Quality of Life 11:37 - Uncovering Hidden Patient Burdens and Costs 14:44 - Integrating Chemoablation into Practice 18:20 - ENVISION QoL Study Setup 22:04 - Comparing TURBT Preferences 27:40 - Counseling Risk-Averse Patients 29:10 - Community Adoption Advice 31:59 - Upcoming Clinical Trials 35:28 - Biomarkers and Expanding Access 36:23 - Final Thoughts and Closing Remarks --- More about this episode The conversation covers practical strategies like office-based surveillance and fulguration for small recurrences, identifying triggers for returning to the OR, and recognizing the hidden burdens of TURBT complications such as hematuria, incontinence, and unplanned ER visits. Dr. Peyton reviews the role of chemoablative options for selected patients, discusses trial data on patient-reported outcomes, and addresses the mixed evidence, high costs, and need for individualized decision-making. The episode also explores new intravesical and FGFR-targeted therapies, underscores the importance of cost-conscious adoption and biomarkers, and considers how management approaches must evolve, especially in community practice settings. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app