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.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (77)
Richard T. Bryan
University of Birmingham, Birmingham, United Kingdom
Wenyu Liu
Sarah J. Pirrie
Rashid Amir
Jean Gallagher
Ana I. Hughes
Allen Knight
Action Bladder Cancer UK, Tetbury, United Kingdom
Veronica Nanton
Harriet P. Mintz
Ann M. Pope
Douglas G. Ward
University of Birmingham, Birmingham, United Kingdom
Steven J. Kennish
Douglas Ward
Naheema Gordon
Sarah Pirrie
University of Birmingham, Birmingham, United Kingdom
Sophia Magwaro
Ann Pope
Ana Hughes
Hiede Doyle
Jacob Cherian
Lyndsay Scarratt
Dawn Johnstone
Denise Hadfield
Amy Slack
Kingsley Ekwueme
Amanda Jones
Bethan Wyn Owen
Lyndon Gommersall
Mark Kitchen
Michelle Davies
Vinodh Murali
Giles Hellawell
Prasanna Gurung
Paul Hunter-Campbell
Lyn Cogley
Gokul Kanda Swamy
Ellen Turrell
Maria Johnstonem
James W.F. Catto
Division of Clinical Medicine, University of Sheffield, Sheffield, United Kingdom
Steven Kennish
Sheffield Teaching Hospitals, Sheffield, United Kingdom
Aidan P. Noon
Marcus G.K. Cumberbatch
Derek J. Rosario
Louise Goodwin
Katharine Behennah
Ferekh Salim
Syed A. Hussain
Sanjeev Kotwal
Christopher Main
Vivekanandan Kumar
Mark Harmer
David Mak
Will Taylor
Baljinder Rai
Amar Mohee
Hosam A Noweir
Houda Chea
Thiagarajan Nambirajan
Nina Patrick
Vandan Arora
Ya-Wen Jessica Huang
Prashant Patel
Amar Manandhar
Rosie Henvey
Kieran P. Jefferson
Davina Hewitt
Anthony Blacker
Donald MacDonald
James Harding
Yakhub Khan
Altan Omer
Andrew Chan
Massachusetts General Hospital, Boston, Massachusetts, United States
Diokno Michael
Nicholas D. James
Institute of Cancer Research, Sutton, United Kingdom
Bernard Sui
Josh Shur
The Royal Marsden NHS Foundation Trust, London, United Kingdom
Vincent Khoo
The Royal Marsden NHS Foundation Trust, London, United Kingdom