I also have been to Thailand a couple times. I was surprised to see many elephants. I love elephants and being in temples. I wish I could go back there, but my wife says" NO". I am not sure how different in the treatment of bladder cancer in Thailand and in NA, but literatures published by Thai indicates the treatment are similar.
academic.oup.com/jjco/article/45/11/1007/2384918
Cisplatin based chemotherapy such as Gemcitabine + Cisplatin or MVAC ( 4 different chemo drug including Cisplatin) are standard chemotherapy used before radical cystectomy (RC). The chemotherapy is systemic so it goes all over the body and supposed kill invisible bladder cancer cells which may have escaped from bladder. Various studies show about 10% improvement on over all survival rate with neoadjuvant chemotherapy compared with those who did not received the chemotherapy before RC. So, you completed 75% of neoadjuvant chemotherapy, which is great.
The next step is that you need to make a choice of urinary diversion -neobladder or ilia conduit or simply put it bag or no bag.
Since you are 67, and if you do not any physical problems, you will be a good candidate for neobladder. When I searched in the internet, I have found an article by a Thai hospital that they have been doing neobladder urinary diversion using robot assisted since 2005. Ileal neobladder, Studer neobladder and Hautmann ileal neobladder procedures are all popular in Thailand . RC should be done by a well experienced surgeon for the urinary diversion of your choice in a large hospital. Also, choose the surgeon who has done nerve sparing successfully. About 50% of patients who goes through RC will experience erectile dysfunction (impotence).
After RC, difference can exists in treatment in US and Thailand. Up to recently, after RC, patients are put on surveillance by regular CT scan to detect metastasis as early as possible.
In some cases, bladder cancer recurs even RC. Once metastasis was detected, the first line treatment is chemotherapy. Up to here, treatment in the US and in Thailand should be the same.
Majority of patients with RC will not experience recurrence but some patient experience metastasis. This is where treatment in Thailand and the US can be different, mostly because of high cost of new treatments. When the chemotherapy did not work, in the US, patient is treated with immunotherapy. as 2nd line treatment. When immunotherapy did no work, PADCEV chemotherapy targeted to bladder cancer cells as 3rd line treatment, then if PADCEV does not work, another bladder cancer targeted treatment Trodelvy can be offered as 4th line treatment.
In recent years, immunotherapy (Nivolumab) has been approved as maintenance after RC for RC patients with high risk of recurrence. Also, another immunotherapy (Avelumab) was approved as adjuvant treatment after chemotherapy. Those treatment improved recurrence free survival and over all survival rate. Cancer drugs including immunotherapy drugs are quite expensive, each costs about $100K per year list price. I do not think many patients cannot afford those treatment even in the US unless Medicare covers it and the US government's policy to enable to afford those expensive treatment.
I am pretty sure that drug companies have different pricing models for countries like Thailand. Also, the insurance scheme may be different in Thailand, Anyway, I hope you will not experience metastasis after RC as many others did not.
best
Topic Author