Joey Wahler (Host): One of the most common non-skin cancers in the U.S. is bladder cancer. So, we're discussing how it's detected using a blue light cystoscopy. Our guest, Dr. Jaspreet Singh. He's Co-Director of Men's Health and Urology Services at Montefiore St. Luke's Cornwall.

Welcome to DocTalk, presented by Montefiore St. Luke's Cornwall. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Singh. Thanks for joining us.

Dr. Jaspreet Singh: Hi there, thanks for having me.

Host: So, some may know what a cystoscopy is, generally speaking, but about a blue light cystoscopy?

Dr. Jaspreet Singh: Yeah. So, a cystoscopy, just to cover the basis, is a procedure that we often do as urologists in the office. And we use that instrument to pass a small, thin tube-like instrument into the bladder. And that allows us to pick up any sort of abnormality of the bladder, the urethra that runs through the prostate, and then just the general urethra. And we use this for both men and women.

Blue light cystoscopy is somewhat unique, and this particular technology has allowed us the ability to diagnose and perhaps find bladder cancer at an earlier age, and also for patients who have a diagnosis of bladder cancer who are on a surveillance protocol to make sure that we are on top of things to be able to find any recurrences at a sooner stage.

Host: Well, you mentioned finding it early and, of course, early detection is key in so many medical areas. But in this case, give people an idea of how important it can be to catch it early on.

Dr. Jaspreet Singh: Yeah. Fortunately, most bladder cancers are superficial, non-muscle invasive, and the reason being, one of the first presenting symptoms of bladder cancer is blood in the urine. And that can be either microscopically, when you go to the doctor's office and they check your urine sample. or perhaps a patient experiencing the gross or visible blood in the urine. And fortunately, because of that symptom, the ability to have patients come into the doctors with that complaint allows us to pick up bladder cancer a little bit early.

On that note, Joey, it's so important to not ignore that symptom. I see patients who may have blood in the urine and it resolves on its own and won't come in to see their doctor. And that, in itself, the delay in coming into the doctors, can delay the diagnosis of what could be an earlier catch on bladder cancer.

Host: So, you're saying just because that symptom may come and go doesn't mean you're out of the woods, you should get it checked out right away, right?

Dr. Jaspreet Singh: That's correct.

Host: So when we say blue light, give people an idea of what you see as the doctor when you go in.

Dr. Jaspreet Singh: So, the blue light cystoscopy is a two-step process. Bladder cancer is a type of cell that is reproducing at a quicker rate than a normal bladder cell would. And because of that higher metabolism, it requires nutrition and is going through metabolism at a quicker rate. So, the two-step process is actually injecting, or instilling rather, a dye, so to speak, or an agent that can highlight the tumor inside the bladder before we go in with the camera. This is done typically an hour before the cystoscopy procedure, where there is a small tube that's placed into the bladder. And this agent, called Hexfix or Cysview, is instilled into the bladder. And it's not a big amount, it's only about two ounces that gets instilled. And what it does is, and when the catheter is put in to put the agent in, the catheter is removed almost immediately, that agent dwells in the bladder. And that agent then gets absorbed by cells that are metabolizing at a high rate, i.e., bladder cancer cells. And so, when we go to the operating suite or into the office, when we look in with a regular camera, we traditionally use what's called white light cystoscopy, which is our ambiance light that we have. And that allows us to pick up bladder tumors, and that's our traditional way of looking into the bladder.

And yes, most bladder tumors, fortunately, are growths that will stick out, but it's when these bladder tumors are flat or specifically a type of tumor that's called carcinoma in situ, may be missed on regular white light cystoscopy.

So, what the surgeon does is after the standard look-in with the white light, we flip over the camera to a what's called a blue light filter. And all light is a different wavelengths. And so when we change it to a specific wavelength, the tumors themselves that are now absorbed, this agent, Cysview, will highlight and they look pink. And it's very easy to recognize these bladder tumors, which may be missed by regular white light cystoscopy.

Host: Interesting. And this is relatively new, right?

Dr. Jaspreet Singh: Well, new to the area here. And, one of the things Montefiore St. Luke's Cornwall has done is really recognize the utility of this technology and has brought it to the community here. In an academic situation, perhaps patients might've had to drive down to the city, the technology has been out and was FDA approved back in 2010. Now, it's been slow to adoption because of the fact that it requires capital and being able to get the equipment that's needed and also a program that needs to be established so that their ability to get the agent, to have the nursing staff instill the agent and for the surgeons to use the technology has what's been slow in adaption. And I'm really excited to kind of share this with the Montefiore St. Luke's community is that we really propel the bladder cancer care to what would be traditionally viewed as the city level care. And that's really what's exciting to offer my patients.

Host: Interesting. And so, what's that been like for you and yours to have this technology more readily available?

Dr. Jaspreet Singh: You know, it really completes the profile and being able to offer patients the ability to diagnose and also surveillance bladder cancer. Bladder cancer in general is a disease that often will reoccur. And so, there's a strict protocol or an algorithm that patients who do have or have been diagnosed with bladder cancer often have to see the urologist every 3 to 6 months over the course of 5 years. And what this technology allows us to do is pick up those easily missed tumors. It allows us to then also, at the time of treatment of bladder cancer, for example, one of the ways we take care of bladder cancer in the operating room is we use an instrument to resect or scrape out through the urethra.

And so, we can use this technology, knowing that at the time of resection, we can flip over the blue light, we can make sure that the margins that we are trying to achieve in getting our margins clear of the bladder tumor, as well as making sure that we preserve healthy tissue and that's also important in limiting our resection to what's needed. So, it really has allowed the comfort level of the urologist at Montefiore St. Luke's to be able to identify and appropriately treat the bladder tumor with minimal damage that may occur to removing healthy tissue.

Host: That sounds great. So, that's from the doctor's standpoint. How about for the patient? It's a relatively simple procedure, yes?

Dr. Jaspreet Singh: Yeah. So, the nice thing about blue light cystoscopy is the only thing that is different than traditional white light cystoscopy is the need for the agent to be instilled one hour before the procedure. And medicine is delivered through a small tube called a catheter. And it's a process that takes perhaps 45 seconds to a minute. The catheter is not left in place. It's a quick in, put the medicine through the catheter and then remove the catheter. And that's really the only thing that's different than white light cystoscopy. So, the trade-off or the return on investment really outbeats the discomfort that one may feel for 30 to 45 seconds.

Host: So with this increased accuracy that you're able to achieve, it must make you, I would imagine, more confident in making a diagnosis once you go in there, yes?

Dr. Jaspreet Singh: For sure, Joey. I mean, this is now allowing me to reassure patients that when I leave the operating room, that I was able to fully resect the tumor, and then also provide me and my patients with reassurance that every time we look in, that the cancer is not present.

Host: How about on the flip side? Are there cancer patients, bladder cancer patients, for whom this procedure is not helpful?

Dr. Jaspreet Singh: Yeah. So most of the time, as I stated earlier, that bladder cancer is a superficial disease, which means it's not invading through the muscle of the bladder. Patients who have muscle-invasive bladder cancer will not benefit from this type of procedure. But 80% of men and women that have bladder cancer, it is superficial. So, a bulk of our patients in our community will benefit from this technology.

Host: And so, in summary here, what would you tell those listening about the ease, but also the effectiveness of this blue light cystoscopy procedure?

Dr. Jaspreet Singh: Yeah. To summarize, Joey, I think what we have now brought to our community, which is at the present time not existent in the Mid Hudson Valley and is only available at Montefiore St. Luke's, is the ability to provide patients the assurity that we're able to diagnose bladder cancers at a sooner stage. We are more comfortable at removing the bladder cancers at the time of the procedure, more securely knowing that we were able to resect the tumors, and then obviously to spare the healthy tissue when removing these cancers. I'm really excited to have this in my tool belt, so to speak, and excited to be able to share this technology with the patients.

Host: Well, folks, we trust you're now more familiar with blue light cystoscopy technology, Dr. Jaspreet Singh, continued success with it, and thanks so much again.

Dr. Jaspreet Singh: Thanks, Joey.

Host: And for more information, please visit montefioreslc.org. Again, montefioreslc.org. Please remember to subscribe to, rate, and review this podcast, and all the other Montefiore St. Luke's Cornwall podcasts as well. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to DocTalk presented by Montefiore St. Luke's Cornwall.