Optimizing Care of Bladder Cancer in Women - Katie Murray

May 28, 2023

Katie Murray joins Ashish Kamat discusses optimizing care for bladder cancer in women. Dr. Murray highlights the need to understand the biologic and diagnostic differences, as well as the timing of diagnoses and survival disparities in bladder cancer among women. She emphasizes the importance of raising awareness among primary care physicians and advocating for early diagnosis, as women often experience delays due to misdiagnosis. Dr. Murray also addresses the need for counseling and discussions about sexual function for women undergoing treatments like radical cystectomy, acknowledging that this topic has historically received less attention in urology. She suggests leaving at least one ovary intact during surgery when oncologically appropriate. Dr. Murray concludes by emphasizing the importance of awareness, reducing late diagnoses, enrolling women in clinical trials, and conducting surgical clinical trials for improved outcomes in bladder cancer care.


Katie Murray, DO, MS, FACS, Urologic Oncology, NYU Langone Health, New York, NY

Ashish Kamat, MD, MBBS, Professor, Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, President, International Bladder Cancer Group (IBCG), Houston, Texas

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Ashish Kamat: Hello. It's a distinct pleasure to welcome Dr. Katie Murray, who's Associate Professor at NYU to join us today at UroToday. So Katie, we're all excited to hear your talk, and thank you for taking the time from your busy schedule here at AUA and joining us today. If you could share with our viewers your insight into optimizing the care of bladder cancer in women, we'd love to hear.

Katie Murray: Yeah. So I think, thanks so much for having me, first of all. It's a pleasure to sit and chat with you about this. And as you mentioned, tomorrow at the SUO I'll be giving a talk, short talk, on bladder cancer in optimization to care in women. And clearly, that is something that we need to be looking at.

So when I first got asked to give this talk, I said, "What does that mean? What do you want me to talk about? Do we want to talk about the specifics of the surgeries and the operations that we do? Do we want to talk about the early diagnosis or the misdiagnosis enrollment in clinical trials? Where does this go?" And they said, "All of the above." And I think that really comes to the point of something, and it's really in the last few years, something that's really come up where we really need to understand that there is a difference, biologic differences, there's diagnostic differences and the timings of those diagnoses, survival differences. And then of course, really a focus on the operations that we do and how that may or may be different for different patients and what that long-term follow up and quality of life looks like with bladder cancer and after bladder cancer in so many patients, with a focus on women.

Ashish Kamat: Yeah, no, it's a topic that's been near and dear to me for many, many years, and it's great to see folks like yourself taking the lead and the charge and bringing out attention of people to this. You touched upon a few things. You touched upon diagnosis, and we know that traditionally women have had a delay in diagnosis. Are you noticing an increase in patients being sent to you earlier with more awareness of bladder cancer amongst primary care physicians, for example?

Katie Murray: Sure. I think there's definitely more of an awareness. I do feel like over the last few years I've gotten a lot more questions, even from primary cares about some of the screening guidelines for microscopic hematuria, the screening guidelines for hematuria from our primary care physicians, whether that be advanced care providers or family practitioners or internists that are really starting to be aware of this as well.

And I think that's becomes a big part of our responsibility as urologists and urologic oncologists. We've got to be out there with our advocacy groups and all of this and shouting the word out that this isn't just a male related cancer. And it's oftentimes gets pushed off on other causes. As for you, for women, they have these complaints of what we might call lower urinary tract symptoms, dysuria, discomfort, and it gets pushed off as a urinary tract infection. And so many times we hear those stories in our office when these people show up and they say, "I've been having this for a year or two years," and that may not be the case for our male counterparts. So awareness is so important and it's exciting that our organizations are doing that and our advocacy groups are doing that, and we're all on the same team now pushing that forward.

Ashish Kamat: Speaking of advocacy groups, the Bladder Cancer Advocacy Network has done a great job in getting this out there in front of people. And at the recent meeting, they actually had a panel discussion, and one of the things that we heard from the patients, including one of mine actually, was that they really wished there was more out there in the form of counseling when it comes to sexual function, et cetera, for women undergoing, for example, a radical cystectomy. What has been your approach to that?

Katie Murray: Yeah, so I think it's something when we think about men, as urologists, that's really been at the meat of our careers for so long, talking about sexual function. As urologists, it's not been at the core of us to really discuss that with our female patients, but I do think that there is an awareness. Being a female myself I do think makes a little bit of difference in having that open, comfortable relationship with patients and really getting that baseline.

There's been some studies out there actually asking us as urologists, how often do you ask patients about their baseline function at the time of bladder cancer diagnosis or at the time of treatment? And the percentage rates of how we responded as urologic oncologists are not great. So we definitely have work that we have to do, but in qualitative analyses of these patients, like you just mentioned, are saying the same thing they're saying, "I wish I knew somebody that was in this same situation. I wish I could have spoken to them." And it's like in so many things, I think the word cancer overcomes people, and it's our job to refocus them that we have treatments for this cancer, but let's think about the other things in life with quality of life, and that often will be sexual function once your treatment is complete and you're in the follow-up stages, et cetera.

Ashish Kamat: When it comes to the quality of life and these issues, one of the things is vaginal sparing.

Katie Murray: Sure.

Ashish Kamat: And reproductive organ sparing. There was this thought that just take out the ovary in all women, but it's clearly beneficial to leave the ovary in place. What is your practice and what would you recommend our viewers and listeners follow?

Katie Murray: Yeah, I think across the board, vaginal sparing has been something we've been talking about for quite some time, and so many surgeons do attempt to do that when it's oncologically appropriate, of course. But oncologically appropriate for the ovaries is a very different conversation, and it's a conversation that we never had. But I do think it's extremely safe and we've clearly been shown some of the benefits of that from the gynecologic literature. And then there's been experiences, of course with urologists that it's not necessary. You don't have to take out the ovaries. So my practice would be to leave at least one if you can.

Ashish Kamat: Great.

Katie Murray: Which is most of the times, right?

Ashish Kamat: Absolutely. Right. Well, again, I want to thank you for taking the time and maybe ask you any closing thoughts you want to leave our viewers with.

Katie Murray: I think we've really touched on everything with the most important is really just being this awareness of that this is not just a disease of men. We've got to cut down on that late diagnosis for women. When I think of trials, we've got to get the women enrolled in these clinical trials. We've got to be doing surgical clinical trials for all of these diseases. So exciting stuff.

Ashish Kamat: Great. Thanks again for taking the time.

Katie Murray: Sure. Thank you.