Randomized comparison of magnetic resonance imaging versus transurethral resection for staging new bladder cancers: results from the prospective BladderPath trial
Abstract
Purpose: 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.
Patients and methods: 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.
Results: 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.
Conclusion: 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.
Author
Bryan, Richard T
Liu, Wenyu
Pirrie, Sarah J
Amir, Rashid
Gallagher, Jean
Hughes, Ana I
Jefferson, Kieran P
Knight, Allen
Nanton, Veronica
Mintz, Harriet P
Pope, Ann M
Cherian, Jacob
Ekwueme, Kingsley
Gommersall, Lyndon
Hellawell, Giles
Hunter-Campbell, Paul
Kanda Swamy, Gokul
Kotwal, Sanjeev
Kumar, Vivekanandan
Mak, David
Mohee, Amar
Nambirajan, Thiagarajan
Ward, Douglas G
Kennish, Steven J
Catto, James W F
Patel, Prashant
James, Nicholas D
Liu, Wenyu
Pirrie, Sarah J
Amir, Rashid
Gallagher, Jean
Hughes, Ana I
Jefferson, Kieran P
Knight, Allen
Nanton, Veronica
Mintz, Harriet P
Pope, Ann M
Cherian, Jacob
Ekwueme, Kingsley
Gommersall, Lyndon
Hellawell, Giles
Hunter-Campbell, Paul
Kanda Swamy, Gokul
Kotwal, Sanjeev
Kumar, Vivekanandan
Mak, David
Mohee, Amar
Nambirajan, Thiagarajan
Ward, Douglas G
Kennish, Steven J
Catto, James W F
Patel, Prashant
James, Nicholas D
Date
2025-01-14
Type
Article
Subject
Oncology. Pathology., Radiology, Surgery
Collections
Citation
Bryan RT, Liu W, Pirrie SJ, Amir R, Gallagher J, Hughes AI, Jefferson KP, Knight A, Nanton V, Mintz HP, Pope AM, Cherian J, Ekwueme K, Gommersall L, Hellawell G, Hunter-Campbell P, Kanda Swamy G, Kotwal S, Kumar V, Mak D, Mohee A, Nambirajan T, Ward DG, Kennish SJ, Catto JWF, Patel P, James ND; BladderPath Collaborative Group. Randomized Comparison of Magnetic Resonance Imaging Versus Transurethral Resection for Staging New Bladder Cancers: Results From the Prospective BladderPath Trial. J Clin Oncol. 2025 Apr 20;43(12):1417-1428. doi: 10.1200/JCO.23.02398. Epub 2025 Jan 14. Erratum in: J Clin Oncol. 2025 May 20;43(15):1847. doi: 10.1200/JCO-25-00779.
Journal / Source Title
Journal of Clinical Oncology
DOI
10.1200/JCO.23.02398
PMID
39808757
Publisher
American Society of Clinical Oncology
Publisher’s URL
https://ascopubs.org/journal/jco