MRI Pathway Speeds Up Bladder Cancer Treatment Time

TOPLINE:

Using multiparametric MRI (mpMRI) before surgery reduced time to correct treatment by 45 days for patients with muscle invasive bladder cancer. The imaging procedure was successful for over 92% of participants with possible muscle invasive bladder cancer who had mpMRI.

METHODOLOGY:

• Delays in definitive treatment for muscle invasive bladder cancer are ubiquitous and deleterious, with a 6%-8% increase in risk for death for every 28-day delay.
• In the United Kingdom, patients with muscle invasive bladder cancer wait an average of 144 days from community referral to radical therapy, and 48% wait > 180 days from diagnosis to cystectomy.
• A prospective open-label, randomized study conducted across 17 hospitals in the United Kingdom included 143 participants with suspected new bladder cancer, randomly assigned 1:1 to transurethral resection of bladder tumor (TURBT) or mpMRI-staged care between May 31, 2018, and December 31, 2021.
• Participants were stratified by sex, age (less than 75/≥ 75 years), and clinician visual assessment of stage, with those unable or unwilling to undergo mpMRI or with previous bladder cancer being ineligible.
• Primary outcomes included feasibility assessment and time to correct treatment for muscle invasive bladder cancer, with a median follow-up duration of 23.7 months.

TAKEAWAY:

• Median time to correct treatment for participants with muscle invasive bladder cancer was significantly shorter with initial mpMRI (53 days; 95% CI, 20-89 days) than with TURBT (98 days; 95% CI, 72-125 days; P = .02).
• A Cox model adjusting for stratification factors demonstrated a hazard ratio of 2.9 (95% CI, 1.0-8.1) in favor of the mpMRI pathway vs the TURBT pathway.
• For participants with non–muscle invasive bladder cancer, no significant difference was observed in median time to correct treatment between mpMRI (17 days; 95% CI, 8-25 days) and TURBT (14 days; 95% CI, 10-29 days; P = .67).
• Among participants with possible muscle invasive bladder cancer randomly assigned to the mpMRI pathway, 92% (95% CI, 79%-98%) successfully underwent the imaging procedure.

IN PRACTICE:

“Incorporating mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected [muscle invasive bladder cancer],” the authors of the new study wrote. “TURBT could be avoided in a proportion of these patients. This approach can improve decision-making and accelerate time to treatment,” they added.

SOURCE:

This study was led by Richard T. Bryan, PhD, University of Birmingham, Birmingham, England. It was published online on January 14 in the Journal of Clinical Oncology.

LIMITATIONS:

According to the authors, COVID-19 interrupted recruitment, preventing enrollment of sufficient participants for survival outcomes analysis. Additionally, the pathologic stage remained unknown in participants who underwent systemic chemotherapy, radiotherapy, or palliation for mpMRI-diagnosed muscle invasive bladder cancer, making it impossible to verify if these were the correct treatments. The researchers also noted that 6 of 17 patients reported as having muscle invasive bladder cancer by mpMRI were subsequently diagnosed as non–muscle invasive bladder cancer, suggesting a learning curve for optimal diagnosis.

DISCLOSURES:

This study was supported by the National Institute for Health Research Health Technology Assessment Program. Bryan disclosed receiving research funding from Janssen, QED Therapeutics, and Urogen Pharma and serving as a consultant for Cystotech ApS, Informed Genomics Ltd, and AstraZeneca. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.