Leading Urology Department Built on Innovative Bladder Cancer Research and Care
If there was a Mount Rushmore of bladder cancer pioneers, Edward Messing, M.D., F.A.C.S., would be on it. A celebrated expert in urologic oncology, Messing conducted breakthrough research that revolutionized bladder cancer care, and contributed to the foundation of the University of Rochester Medical Center’s Department of Urology, a leading provider of advanced urological care.
Understanding that early detection of bladder cancer is critical, Messing led the study resulting in the first simple, at-home urine test to screen for the disease. He also published a landmark study concluding that bladder cancer screening in healthy men can lead to earlier detection and reduced mortality.
Improving patient care through studies comparing novel treatments to existing ones is the focus of much of his research. Dr. Messing’s studies have explored whether instillation of a chemotherapy drug (gemcitabine) immediately after removal of a bladder cancer could reduce the likelihood of tumors recurring. Among studied patients with suspected low-grade non-muscle-invasive urothelial cancer – which frequently recurs after excision by transurethral resection of bladder tumor (TURBT) – immediate postresection intravesical instillation of gemcitabine significantly reduced the recurrence risk.
Messing and the team at URMC are currently studying whether bladder cancer has molecular features that can predict response to gemcitabine, including whether certain enzymes that metabolize gemcitabine rapidly could make cancer cells more resistant to it.
A related project that Messing and URMC are involved with is exploring how an implementation science framework can increase rates of instilling postoperative intravesical chemotherapy in patients with suspected low-grade, nonmuscle-invasive bladder cancer, thereby improving cancer care while reducing patients’ suffering and medical costs.
His work in bladder cancer research and urologic education was recognized in 2013 with the prestigious Presidential Citation from the American Urological Association; in 2018 with the AUA’s highest honor, the Ramon Guiteras Award; and in 2022 with the Edward L. Keyes Medal, the highest honor given by The American Association of Genito-urinary Surgeons.
“Any accolades I’ve received, I also share with my colleagues in the Department of Urology,” Messing said. “I picked up the mantle from the Department chairs before me, such as Abraham Cockett, M.D., and Irwin N. Frank, M.D.” Messing is currently AUA president, a position that both Abe Cockett and Irwin Frank previously held.
Building on the foundation
Messing served as Urology chair for 23 years. Under his leadership, the Department was at the forefront of advanced bladder cancer care. The Department has continued to build a team of outstanding researchers and surgeons, who are blazing a new trail in research and patient care.
Messing’s research is being expanded on by the next generation of urologists that he helped recruit and continues to mentor. URMC’s bladder cancer research focuses on both the development and management of the disease.
One of those researchers is William B. Tabayoyong, M.D., Ph.D., who specializes in surgical treatment for urologic cancers. Tabayoyong’s research focuses on how bladder cancer often escapes from attack by the patient’s immune system.
“Ed Messing was one of the main reasons I came to URMC following my fellowship, to learn from him and to help usher in the next wave of research here,” Tabayoyong said. “Among one of the subjects I studied in my fellowship was immune checkpoint pathways – the way in which bladder cancer signals to the immune system to turn itself off. One of the leading researchers was at MD Anderson and I am continuing that research now.”
In another current clinical trial, Tabayoyong is looking at whether improving nutrition before and after surgery reduces the infections and other problems that can occur after bladder cancer surgery. This study is exploring how well nutrition therapy works in improving the immune system in patients with bladder cancer that can be surgically removed.
According to Tabayoyong, Urology specialists are following Messing’s lead by dedicating themselves to providing the best patient care and by pushing the envelope with their clinical trials portfolio. “Our team of dedicated experts is utilizing clinical trials and translational science to find the most revolutionary bladder cancer treatments.”
One area of focus in the team’s research is working to better understand gender differences in bladder cancer.
“There will be about 83,000 new bladder cancer cases this year, bladder cancer is the fifth most common cancer among men, and it is predominantly a male disease but the reasons for that is not clear,” Messing said. “While bladder cancer is one-third as common among women as men, women’s lives are more at risk from the disease than men’s are.”
Over the last 30 years, there has been some improvement in bladder cancer outcomes, according to Messing, but progress has not been fast enough. “Three decades ago, 25 percent of patients with bladder cancer died from the disease; today, that number has decreased only to about 23 percent. Clearly, more work needs to be done to improve patient outcomes.”
Early detection continues to be critical, especially for non-muscle invading bladder cancer that can often be treated by medicines and other strategies. Messing has conducted several studies on blood in urine. Using a chemical re-agent strip, he found that tumors destined to become muscle invading can be detected (and treated) before they invade the muscle layer.
More research is needed to explore additional screening methodologies to reduce bladder cancer deaths by catching the disease before cancer cells invade the muscle.
That work will be key of the Department going forward.
URMC Urology Chair Jean Joseph, M.D., M.B.A., F.A.C.S., said, “Ed Messing is a pioneer who transformed bladder cancer patient care. Our Department continues to advance his legacy and his work through evidence-based research and by providing the best possible care for patients. This includes innovative programs where we offer increased sub-specialization to care for the most complex bladder cancer cases and look at the whole patient.”
The view of the “whole patient” includes conducting outcome meetings to review data, identifying the best protocols for streamlined patient care, and providing a nutritional assessment to better prepare patients for the stress of surgery.
“Our patients continue to benefit from Ed Messing’s accomplishments in scientific discovery and from his approach to urological care, which are at the core of the work of our next generation of urologic researchers and providers,” Joseph added. “Working from the foundation he and other past department chairs constructed, our team of experts is committed to improving outcomes for patients with bladder cancer.”