AUA 2025: Detectable Pre-Cystectomy ctDNA Status for Patients with Non-Muscle Invasive Bladder Cancer Correlates with Adverse Radical Cystectomy Outcomes and Poor Prognosis

(UroToday.com) The American Urological Association (AUA) 2025 Annual Meeting, held in Las Vegas, NV, between April 26th and 29th, 2025, was host to a non-invasive bladder cancer interactive poster session. Dr. Reuben Ben-David presented the results of a study evaluating the correlation between pre-cystectomy circulating tumor DNA (ctDNA) status and oncologic outcomes in non-muscle invasive bladder cancer (NMIBC) patients undergoing a radical cystectomy.

The objective of this study was to assess the utility of ctDNA in NMIBC for patients undergoing a radical cystectomy.

Patients who underwent a radical cystectomy for NMIBC had prospectively and longitudinally collected ctDNA analyses (SignateraTM) between 2021 and 2023. The ctDNA status was informed from the pre-cystectomy specimen. The minimal residual disease (MRD) window was defined as the initial 90 days after surgery. Recurrence-free survival (RFS) was evaluated using the Kaplan-Meier method for patients with a follow-up period >3 months (n=42).

Overall, 49 patients underwent radical cystectomy for NMIBC. The median age was 67 years (IQR: 62–72), and the median follow-up was 13 months (IQR: 6–16).

Overall, ten patients (23.8%) had disease recurrence. Detectable pre-cystectomy ctDNA status was more commonly associated with:

  • Upstaging to muscle-invasive disease
  • ≥pT3 disease
  • pN+ disease
  • Disease recurrence

Patients with detectable pre-cystectomy ctDNA had worse RFS outcomes, compared to patients with undetectable ctDNA, with a median RFS of 10.8 months versus not reached, respectively.
Dr. Ben-David concluded that among NMIBC patients who undergo a radical cystectomy, those with detectable pre-cystectomy ctDNA levels had higher risks of pathological upstaging, nodal disease, and poor oncological outcomes, compared to those who were ctDNA-negative.

Presented by: Reuben Ben-David, MD, Society of Urologic Oncology (SUO) Fellow, Icahn School of Medicine, Mount Sinai Hospital, New York, NY

Written by: Rashid K. Sayyid, MD, MSc – Robotic Urologic Oncology Fellow at The University of Southern California, @rksayyid on Twitter during the 2025 American Urological Association (AUA) annual meeting held in Las Vegas, NV, Saturday, April 26 - Tuesday, April 29, 2025

Related content: Pre-Cystectomy ctDNA Levels and Metastatic Recurrence in Bladder Cancer Patients - Reuben Ben-David