ESMO 2022: First Results from BladderPath: A Randomised Trial of MRI Versus Cystoscopic Staging for Newly Diagnosed Bladder Cancer

( In the Mini Oral session of the European Society for Medical Oncology (ESMO) Annual Congress focusing on non-prostate genitourinary cancers, Dr. James presented the first results of the novel BladderPath trial examining the role of magnetic resonance imaging (MRI) for bladder cancer staging. For more than 100 years, transurethral resection of bladder tumour (TURBT) has been the mainstay of bladder cancer staging. These authors believed that image-directed staging may allow for more timely definitive therapy for patients with suspected muscle invasive bladder cancer (MIBC).

The authors enrolled patients with suspected bladder cancer through the haematuria clinic. Based on the potential for muscle invasive disease (assessed on a Likert scale at flexible cystoscopy), patients were enrolled and were randomised to standard of care with TURBT assessment (Pathway 1) or MRI based assessment (Pathway 2) with tumour biopsy. Patients who were felt, based on cystoscopy, to have probable non-muscle invasive disease (NMIBC) all underwent TURBT.


In the initial Feasibility Phase, the primary outcome was the proportion of patients completing allocated pathway (target 80%). Subsequently, during the Efficacy Phase, the primary outcome was time to correct treatment, defined as TURBT for NMIBC or the first of chemotherapy, radiotherapy, surgery or decision for palliative care for MIBC (target: 30 day improvement).

The authors randomized 143 patients between May 2018 and December 2021. The median age of enrolled patients was 74 years. Based on cystoscopic assessment, 47.9% of patients were assessed to have probable NMIBC while 52.1% were assessed to have possible MIBC.

During the initial Feasibility phase, 37 of 39 (95%, 95% CI 83-99%) patients with MIBC followed the correct pathway, exceeding the target of 80%.

Subsequently, during the Efficacy phase, the median time to correct MIBC treatment was 98 (95% CI 72-174) days for patients in the traditional Pathway 1 and 53 (95% CI 20-89) days for patients in Pathway 2 (logrank test: p-value= 0.0046).


This corresponds to a hazard ratio (HR) of 3.4 (95% CI 1.4-8.3). Among secondary outcomes, the median time to correct treatment among all patients was non-significantly shorter among patients in Pathway 2 (31 days) compared to Pathway 1 (37 days; HR 1.3, 95% CI 0.9-1.8).

Thus, Dr. James concluded that the use of an MRI directed pathway led to substantial shortening of time to correct treatment for MIBC patients with no detrimental effect of time to treatment for NMIBC patients.

Presented by: Professor Nicholas James, MBBS, FRCP, FRCR, Ph.D., Professor of Clinical Oncology at the Institute of Cancer Research at Royal Marsden Hospital, London

Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2022 European Society of Medical Oncology (ESMO) Annual Hybrid Meeting, Paris, FR, Fri, Sept 9 – Tues, Sept 13, 2022.

email news signup