Bladder cancer continues to be a pressing medical challenge, with different forms requiring different treatment approaches. While at Combat we primarily focus on non-muscle-invasive bladder cancer (NMIBC), recent advancements in diagnosing and treating the more aggressive MIBC are cause for optimism.
The findings of the BladderPath trial, recently published in the Journal of Clinical Oncology, have revealed a far more effective approach to expediting the diagnostic and treatment process for MIBC patients. That is, by using multiparametric MRI (mpMRI) as the first stage of the diagnostic pathway instead of the currently used TURBT (transurethral resection of bladder tumour). This approach not only accelerates treatment timelines but also improves the accuracy of staging while offering cost and resource savings for healthcare systems.
About The BladderPath Trial
The BladderPath trial, conducted across 17 hospitals in the UK, demonstrated that by replacing the traditional transurethral resection of bladder tumour (TURBT) procedure with mpMRI as the initial diagnostic step, treatment for MIBC could be initiated 45 days earlier on average. The main discoveries of the trial were:
Faster Referral-to-Treatment Times:
The median time to begin treatment for MIBC was reduced to 53 days with mpMRI, compared to 98 days when TURBT was used. This 45-day reduction is critical, as every 28-day delay in treatment increases the risk of death by 6–8%.
Improved Staging Accuracy:
TURBT, while effective for NMIBC treatment, has notable limitations for MIBC. It can lead to understaging of high-grade cancers, and post-procedure imaging can be affected by surgical artefacts, making it harder to determine the true extent of the disease. The use of mpMRI pre-biopsy offers a clearer, non-invasive staging method, improving diagnostic precision.
Resource and Cost Savings:
mpMRI is significantly less expensive than TURBT surgery. Additionally, avoiding unnecessary TURBT procedures not only conserves surgical theatre space but also spares patients from undergoing an invasive diagnostic procedure that may delay definitive treatment.
Why TURBT Falls Short for Diagnosing MIBC
While TURBT is used for treating NMIBC, for MIBC, it serves primarily as a diagnostic tool rather than a therapeutic one. The inherent drawbacks of using TURBT for the diagnosis of MIBC include:
- Delays in Treatment: TURBT requires scheduling, completion, and recovery before staging can proceed. This sequence often prolongs the time to definitive treatment.
- Potential Understaging: High-grade cancers may not be accurately staged with TURBT alone, leading to suboptimal treatment decisions.
- Imaging Artefacts: Post-TURBT, imaging methods like CT or MRI often face limitations due to artefacts caused by surgical intervention, which can obscure accurate staging.
Given these challenges, the integration of mpMRI as the first diagnostic step offers a superior alternative.
mpMRI Could Transform the Diagnosis of Bladder Cancer
How multiparametric MRI addresses the limitations of TURBT:
Non-Invasive Precision:
Unlike TURBT, mpMRI provides detailed imaging without requiring an invasive procedure. This enables clinicians to accurately stage tumours and assess their extent before considering further interventions.
Reduced Treatment Delays:
By eliminating the need for TURBT as a preliminary diagnostic step, mpMRI streamlines the process, allowing patients to receive definitive treatment – such as surgery or chemotherapy – sooner.
Patient-Centred Approach:
Patients benefit from fewer invasive procedures, reduced waiting times, and faster initiation of appropriate therapies, improving overall outcomes and quality of life.
Expert Commentary on the Findings
Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research in London, and the chief investigator of the BladderPath study, commented: “This research shows that by adding an MRI pre-biopsy, we can cut the time taken to correct treatment for the worst bladder tumours by almost half.
“As an MRI is considerably cheaper than [TURBT] surgery, we estimate that this new diagnostic procedure will save money, as well as saving surgical theatre space and preventing patients from undergoing unnecessary procedure.”
Future Optimism
We are excited about this latest innovation, and hopeful that the success of the BladderPath trial sets the stage for widespread adoption of mpMRI in MIBC diagnostic pathways. This groundbreaking trial could offer clinicians faster, more accurate, and less invasive care to patients, ultimately improving treatment outcomes and potentially saving countless lives.
