Multicenter prospective trial of initial multiparametric MRI versus transurethral resection for staging of new bladder cancers

Transurethral resection of bladder tumor (TURBT) is the initial staging procedure for new bladder cancers (BCs). In case of muscle-invasive bladder cancers (MIBCs), TURBT may delay definitive treatment. Use of flexible cystoscopic biopsy and multiparametric MRI (mpMRI) might expedite definitive treatment for MIBC. The multicenter prospective BladderPath trial in the United Kingdom randomized participants with suspecten new BC 1:1 to TURBT-staged care (Pathway 1) or mpMRI-staged care with subsequent TURBT only if indicated (Pathway 2). Over 92% of participants with possible MIBC in Pathway 2 underwent mpMRI after randomization. After mpMRI, over 22% of participants with possible MIBC in Pathway 2 received correct therapy without the need for TURBT. Among patients with MIBC, the median time to correct treatment was 45 days shorter in Pathway 2 than in Pathway 1 (p=0.02). The authors conclude that incorporating of mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected MIBC.