Transurethral resection of bladder tumor (TURBT) is the initial staging procedure for new bladder cancers (BCs). For muscle-invasive bladder cancers (MIBCs), TURBT may delay definitive treatment. We investigated whether definitive treatment can be expedited for MIBC using flexible cystoscopic biopsy and multiparametric magnetic resonance imaging (mpMRI) for initial staging.
We conducted a prospective open-label, randomized study conducted within 17 UK hospitals (registered as ISRCTN 35296862). Participants with suspected new BC were randomly assigned 1:1 to TURBT-staged or mpMRI-staged care, with minimization factors of sex, age, and clinician visual assessment of stage. Blinding was not possible. Patients unable/unwilling to undergo mpMRI or with previous BC were ineligible. The study had two stages with separate primary outcomes of feasibility and time to correct treatment (TTCT) for MIBC, respectively.
Between May 31, 2018, and December 31, 2021, 638 patients were screened, and 143 participants randomly assigned to TURBT (n = 72; 55 males, 15 MIBCs) or initial mpMRI (n = 71; 53 males, 14 MIBCs). For feasibility, 36 of 39 (92% [95% CI, 79 to 98]) participants with suspected MIBC underwent mpMRI. The median TTCT for participants with MIBC was significantly shorter with initial mpMRI (n = 12, 53 days [95% CI, 20 to 89] v n = 14, 98 days [95% CI, 72 to 125] for TURBT, log-rank P .02). There was no detriment for participants with non-MIBC (median TTCT: n = 30, 17 days [95% CI, 8 to 25] for mpMRI v n = 28, 14 days [95% CI, 10 to 29] for TURBT, log-rank P = .67). No serious adverse events were reported.
The mpMRI-directed pathway led to a 45-day reduction in TTCT for MIBC. Incorporating mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected MIBC.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2025 Jan 14 [Epub ahead of print]
Richard T Bryan, Wenyu Liu, Sarah J Pirrie, Rashid Amir, Jean Gallagher, Ana I Hughes, Kieran P Jefferson, Allen Knight, Veronica Nanton, Harriet P Mintz, Ann M Pope, Jacob Cherian, Kingsley Ekwueme, Lyndon Gommersall, Giles Hellawell, Paul Hunter-Campbell, Gokul Kanda Swamy, Sanjeev Kotwal, Vivekanandan Kumar, David Mak, Amar Mohee, Thiagarajan Nambirajan, Douglas G Ward, Steven J Kennish, James W F Catto, Prashant Patel, Nicholas D James, BladderPath Collaborative Group
Bladder Cancer Research Centre, Department of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom., The Translational Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom., University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Patient Representative, Tetbury, United Kingdom., University Hospital Coventry and Warwickshire, Coventry, United Kingdom., Warwick Medical School, University of Warwick, Coventry, United Kingdom., MRC Clinical Trials Unit, UCL, London, United Kingdom., The Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom., Betsi Cadwaladr University Health Board-Glan Clwyd Hospital, Rhyl, United Kingdom., University Hospitals of North Midlands-Royal Stoke Hospital, Stoke-on-Trent, United Kingdom., London North West University Healthcare NHS Trust-Northwick Park Hospital, London, United Kingdom., University Hospitals Plymouth NHS Trust-Derriford Hospital, Plymouth, United Kingdom., Swansea Bay University Health Board-Morriston Hospital, Swansea, United Kingdom., Leeds Teaching Hospitals NHS Trust-St James' University Hospital, Leeds, United Kingdom., Norfolk and Norwich University Hospitals NHS Foundation Trust, United Kingdom., The Royal Wolverhampton NHS Trust-New Cross Hospital, Wolverhampton, United Kingdom., Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom., Wirral University Teaching Hospital NHS Foundation Trust-Arrowe Park Hospital, Birkenhead, United Kingdom., Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom., University College London Hospitals NHS Foundation Trust, London, United Kingdom., Institute of Cancer Research, London, United Kingdom.