At 60 years old, just two years into early retirement, Brian Okamoto never expected to be facing cancer. He was always a nonsmoker, a healthy eater, and an active swimmer. 

His first symptoms were easy to dismiss or mistake for aging, including more frequent trips to the bathroom and a trace of blood in his urine on Thanksgiving Day 2016. He brushed them off until a routine checkup led his doctor to schedule a urology appointment right away. Soon after, he learned he had bladder cancer — but endured months of uncertainty about whether the disease had spread.

“For about three months, you don’t really know what your situation is, and that’s when, late at night, like at 2 in the morning, if you wake up and everything’s quiet, that’s when you really have those mental challenges,” Brian recalls. “I was racking my brain, like, what did I do to get this? And turns out that maybe it was nothing. It just might have been chance.”

When test results came back, Brian learned he had a form of early-stage bladder cancer. He was relieved the cancer hadn’t spread into the bladder muscle. He’d need to embark on an intensive treatment path: years of standard of care treatment and lifelong monitoring.

“Once you know, then you have something you can deal with,” he says.

Turning vigilance into vitality

Bladder cancer is considered one of the most costly cancers to treat per patient, largely because it has one of the highest recurrence rates. That reality means patients like Brian must undergo frequent, often uncomfortable testing procedures and remain vigilant for the rest of their lives.

“For me, the mental aspects have been the most difficult in the long run,” Brian says. “I’ve thought about it every day, several times a day, for the past eight and a half years, mostly wondering how I got it, how to avoid it, and if it’s going to recur.”

To cope, Brian leans on what he loves. “Don’t lose your hobbies, nor your friends,” he advises. “Try to stay involved. Don’t lose your life.”

For him, that means swimming four to six days a week with many of the same friends he’s trained with for 40 years. He volunteers with the University of California’s Master Gardener Program and tends to his vegetable beds at home. He and Lisa, his partner of 40 years, often travel in a camper van with their two dogs — meeting up with a community of fellow engineers who tinker with their vans to solve problems along the way. On their most recent trip, they visited Yellowstone National Park, Grand Teton National Park, and Badlands National Park.

Brian also speaks with newly diagnosed patients through Bladder Cancer Advocacy Network’s Survivor to Survivor program. “That’s very rewarding because I know how much it means to talk to somebody else who has gone through it,” he says.

The research journey: from lab to patient

Brian, now 69, has not experienced a bladder cancer recurrence for nearly a decade. But he knows not everyone has the same outcome. Sometimes the treatment doesn’t work at all, other times it works for a period but loses its effectiveness. 

That’s where scientists like Javier Chaparro-Riggers, vice president, BioMedicine Design at Pfizer, come in. He and his team are investigating new immunotherapies that may potentially strengthen the body’s natural defenses against cancer. Normally, the immune system can recognize and destroy abnormal cells, but cancers often find ways to escape detection by dampening immune responses or altering their surrounding environment. Immunotherapy works by countering these evasive tactics. 

“Bladder cancer is really receptive to drugs that reactivate the immune system,” Javier says.

Javier and his team are working on potential therapies that reactivate the patient’s own immune system. Pfizer is testing combination therapies: pairing existing therapies with new immune-activating drugs to push the immune system past the threshold needed to mount a lasting defense.

“It’s always a balance,” Javier says. “You want to reactivate the immune system enough to fight the cancer, but not so much that it causes side effects.”

The work is challenging. Most drugs in the early stages of development never make it to patients. But for Javier, the purpose is clear. “Being somebody who works in the pharma industry or biotech, you want to help patients get better,” he says. “That’s beautiful because you never have to question your purpose.”

Reframing the mind-body connection

When Brian met Javier at Pfizer La Jolla, their conversation quickly turned to what it means to live with bladder cancer day to day, beyond the doctor’s visits and treatments. 

“It’s not like, ‘I have a broken bone, it will heal, and it’s gone.’ It’s more than that because it’s something you most probably have to live with your whole life,” Javier said. He asked Brian about the mental side of bladder cancer and what strategies have helped him.

Brian agreed that while treatment is critical, the mental toll can be just as challenging. “What really helped me was staying active,” he said. “One other thing. You know how you play Dr. Google? Just not a good thing.” 

He described how reading too much online fed an “adversarial relationship” with his body. To change that dynamic, he took an unconventional approach — naming his bladder. “I’ve got Barry the Bladder,” he told Javier. “Late at night, if I’m lying in bed and can’t sleep, I’ll just put my hands over my stomach. Rather than say, ‘Hey, why are you trying to kill me?’ I’ll say things like, ‘I love you. I want to stay with you forever,’ so I develop a healthier relationship with my own bladder.”

Both men laughed at the story, but Javier found wisdom in it. “Naming Barry, your bladder, is an amazing way of dealing with mental strains,” he said. 

“Perhaps when people hear about things like that, they can come up with their own ways too,” Brian said. “You’ve got to think outside the box a little bit and do whatever you can.”

For Javier, whose work is largely in the lab and doesn’t involve meeting patients directly, the exchange was especially meaningful. “It’s really important that we see who we’re helping,” he said. “If you go into the clinic, every data point is a person. We should not forget that because it’s really important. It’s our purpose. It’s what drives us.”