MRI added to biopsy could cut time to treatment for bladder cancer in half

MRI added to biopsy speeds diagnosis and staging of invasive bladder cancer. Image credit – University of Birmingham, UK

CANCER DIGEST – Jan. 18, 2025 – The time to treatment for patients diagnosed with bladder cancer using MRI was half that of patients diagnosed with conventional surgical method of staging bladder tumors, a new study shows.

The study called BladderPath Trial, led by Richard Bryan, PhD, director of the Bladder Cancer Research Center at the University of Birmingham in the UK, randomly assigned 143 patients at 17 hospitals in the UK suspected of bladder cancer of the muscle tissue of the bladder wall, referred to as muscle-invasive bladder cancer or MIBC.

Of the 143, 72 were assigned to the conventional staging method using transurethral resection of the bladder tumor (TURBT) and 71 were assigned to undergo special magnetic resonance imaging that used multiple parameters for zeroing in and evaluating the suspected tumor, followed by TURBT.

The goal of the study was to see if adding the imaging technique would cut the time to accurately stage and treat bladder cancer. The results showed that patients who underwent MRI began treatment within an average of 53 days, compared to 98 days for patient staged with surgery. In addition, 22 percent of the MRI group did not need to undergo TURBT to receive the correct treatment for their stage of cancer. The results appear in the Jan. 14, 2025 Journal of Clinical Oncology.

“Bladder cancer is a common cancer and we know that with any cancer, and especially muscle-invasive bladder cancer, speed is of the essence when treating," Dr. Bryan said in a press release. "Any ways to improve the time from initially suspecting cancer to getting the right treatment gives patients the best chance of responding well."

The conventional staging method for muscular invasive bladder cancer uses a cystoscope, a thin telescope inserted through the urerthra that allows the surgeon to visually examine the tumor and also remove some tissue from the tumor that can be analyzed under a microscope to determine if the tumor has invaded the muscle wall.

Such muscle invasive tumors indicate a much more aggressive stage requiring more robust therapy. While the method is generally well tolerated, in 30 percent to 46 percent of patients initially diagnosed with early stage tumors are upgraded to more aggressive muscle invasive cancer, which requires additional treatment that may include radical cystectomy or removal of the bladder. 

“This research shows that by adding an MRI pre-biopsy we can cut the time to correct treatment for the worst bladder tumors – those that invade the bladder muscle wall – by almost half, from 98 days down to 53 days," Bryan said. "We’ve also shown that around 1 in 7 of these patients with problematic tumors can avoid the surgical procedure used to diagnose bladder cancer."

In addition, the study authors say that using MRI to help doctors determine the appropriate treatment for the stage of bladder cancer earlier, MRI is cheaper than surgery and could prevent patients from undergoing unnecessary procedures.

Sources: University of Birmingham press release and Journal of Clinical Oncology.