Multiparametric magnetic resonance imaging (mpMRI) for the initial staging of muscle-invasive bladder cancer (MIBC) is both feasible and beneficial in reducing treatment delays, a new study shows.
New bladder cancers are initially staged using transurethral resection of bladder tumour (TURBT), however, in the case of MIBC, this may delay the primary treatment. The study therefore investigated whether using flexible cystoscopic biopsy and mpMRI for initial staging would be more effective.
The researchers conducted a prospective open-label, randomised study within 17 UK hospitals between May 2018 and December 2021. Over 600 patients with suspected new bladder cancer were screened. A total of 143 patients were randomly assigned to one of two groups: 72 patients received the standard staging care with TURBT and 71 patients received mpMRI-staged care. The primary outcomes assessed were feasibility and the time to correct treatment (TTCT) for MIBC.
Feasibility was tested on 36 out of 39 participants who had suspected MIBC and were in the mpMRI group. The median TTCT for patients with MIBC was 53 days for the mpMRI group (with a confidence interval of 20-89 days) and was significantly shorter with mpMRI compared to 98 days for the TURBT group (confidence interval of 72-125 days).
For patients without MIBC, the TTCT was similar whether they underwent initial mpMRI or TURBT, and there were no significant differences in primary outcomes between the two groups. The median TTCT was 17 days for the mpMRI group and 14 days for the TURBT group. The researchers reported no serious adverse events in either group.
Secondary outcomes included TTCT for all recruited participants and for those confirmed to have non-MIBC. The correct treatment for non-MIBC was TURBT, while for MIBC it was either chemotherapy, radiotherapy, cystectomy or palliative care.
The findings showed that using mpMRI in the MIBC pathway reduced TTCT by 45 days compared to standard investigation. The researchers concluded that introducing mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected MIBC as it could improve clinical decision making and accelerate the time to treatment.
Reference
Bryan, R et al. Randomized Comparison of Magnetic Resonance Imaging Versus Transurethral Resection for Staging New Bladder Cancers: Results From the Prospective BladderPath Trial. JCO 0 2025, Jan. 14: DOI:10.1200/JCO.23.02398.
