MRI Plus Biopsy as an Alternative to TURBT in Bladder Cancer Staging

In the BladderPath study, researchers explored staging suspected muscle-invasive bladder cancer (MIBC) with MRI and biopsy instead of conventional transurethral resection of bladder tumor (TURBT). Presenting at the ESMO Congress 2022, the study’s lead author, Nicholas James, reported that the randomized trial enrolled 143 patients (median years of age, 74) between May 2018 and December 2021.

Among the participants, 47.9% had probable non-muscle-invasive bladder cancer (NMIBC), and 52.1% had possible MIBC. Patients with suspected MIBC were randomized to assessment via standard TURBT or MRI and biopsy. All patients with probable NMIBC underwent TURBT.

MRI-Alternative to TURBT Yields Superior Time to Correct Treatment

In an initial feasibility phase, the primary end point was the proportion of patients who completed the allocated assessment, with a target of 80%. In the following efficacy phase, the primary measure was the time to correct treatment—TURBT for NMIBC or the first of chemotherapy, radiotherapy, surgery, or elective palliative care for MIBC—with a target of 30-day reduction in time to correct treatment.

During the feasibility phase, 95% of patients with MIBC completed their allocated assessment (37 of 39; 95% CI, 83-99%), James noted. In the efficacy phase, TURBT demonstrated a median time to correct MIBC treatment of 98 days (95% CI, 72-174) compared with 53 days (95% CI, 20-89) with MRI plus biopsy (hazard ratio [HR], 3.4; 95% CI, 1.4-8.3; P=.0046). Additionally, TURBT and MRI-based assessments among all patients led to a median time to correct treatment of 37 and 31 days, respectively (HR, 1.3; 95% CI, 0.9-1.8).

James summarized that “an MRI-directed pathway led to substantial shortening of time to correct treatment for MIBC patients with no detrimental effect of time to treatment for NMIBC patients.”

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