The Feasibility and Efficacy of Multiparametric MRI for Staging Bladder Cancer - Expert Commentary
The randomized trial (BladderPath) consisted of 143 patients who were randomized into pathway 1 involving standard TURBT procedure (n = 72) and pathway 2 involving mpMRI-based assessment (n = 71). Of patients who underwent mpMRI, 47% were diagnosed as MIBC, 44% were diagnosed as NMIBC, and the remaining patients had inconclusive results. The median time to correct treatment (TTCT) for patients initially classified as possible MIBC and then confirmed to have MIBC was 98 days (95% CI, 72 – 125) for pathway 1 and 53 days (95% CI, 20 – 81) for pathway 2 (p = 0.0201). A multivariate Cox analysis revealed that participants in pathway 2 received correct treatment 2.9 times faster than those in pathway 1 (95% CI, 1.0 – 8.1; p = 0.04). The median TTCT for probable NMIBC patients who were confirmed as NMIBC was 14 days (95% CI, 10 – 29) for pathway 1 and 17 days (95% CI, 8 – 25) for pathway 2 (p = 0.6677).
Incorporating mpMRI for initial staging in patients visually diagnosed with possible MIBC at outpatient cystoscopy can significantly expedite correct treatment initiation by 45 days. This faster pathway could enhance patient outcomes, as delays of over three months between diagnosis and radical cystectomy have been associated with adverse results. This study provides support for alternative imaging-based strategies for bladder cancer staging that could expedite definitive treatment.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
References:
Read the Abstract