Chemo Day 66 - changing gears

So much for a relaxing vacation.  In the past 48 hours, I've done the following:

1. Read the European Association of Urology's brand-new 2012 Guidelines on Bladder Cancer, Muscle-Invasive, and Metastatic (available at http://www.uroweb.org/gls/pdf/07_Bladder%20Cancer_LR%20II.pdf).  It's scintillating stuff.  Actually, it's a very readable, comprehensive overview of the latest thinking regarding bladder cancer, including specific recommendations for practitioners.   It also sets forth odds and mortality rates with bloodless candor.  Here's the facts, it says.  Deal with it. 

2.  Exchanged additional emails with my oncologist regarding our pulling the plug on the 4th round of chemo.  She's going to arrange for CT, PET, and MRI scans to check for any evidence that the cancer has spread outside the bladder.  Update: The CT scan is set for Wednesday, April 11.  The insurance company won't pay for the PET scan, and is considering whether to pay for the MRI.  Stay tuned. 

3.  Exchanged emails with Dr. Kamat, at MD Anderson. He is one of the leading authorities in micropapillary bladder cancer.  After summarizing my case and enclosing the pathology reports, I asked the following questions:

1.  What treatment would you advise going forward?
2.  Given the fact that I have bladder cancer with micropapillary and nested features, should I be receiving any additional tests prior to surgery?
3.  What benefit, if any, would there be in having you perform the RC instead of Dr. Schoenberg?
4.  Does it make any sense to meet in person?
5.  Do you need any additional records for your evaluation?

His reply was reassuring that my course of treatment is on the right path:

1. I would recommend that you move ahead with surgery. Our existing neoadjuvant chemotherapy regimens might not be quite as efficient for MPBC and could delay potentially curative surgery.
2. Agree that radiation/bladder sparing is not appropriate for you.
3. No further testing needed in addition to what you have outlined.
4. You are in good hands with Dr Shoenberg. The key thing re: your question about RC is to recognize it is a complex surgery and have it performed by a skilled surgeon with extensive experience/success.
5. The above is not intended to second guess your physicians, of course. As you might recognize, it is hard for me to give you a personalized specific recommendation without examining you/reviewing the slides and images in person, which they have done.


4.  I have exchanged several emails and phone calls with Dr. Schoenberg's office at Hopkins.  I am told that Dr. Schoenberg will want to see the CT and MRI scans, and during the week of April 16, will do a cytoscope examination of my bladder (an outpatient procedure).  Assuming everything checks out, he'll schedule me for the surgery a couple of weeks later, perhaps during the week of April 30.