Randomized Comparison of Magnetic Resonance Imaging Versus Transurethral Resection for Staging New Bladder Cancers: Results From the Prospective BladderPath Trial
Authors: Bryan Richard T. , Liu Wenyu , Pirrie Sarah J. , Amir Rashid , Gallagher Jean , Hughes Ana I. , Jefferson Kieran P. , Knight Allen , Nanton Veronica , Mintz Harriet P. , Pope Ann M. , Cherian Jacob , Ekwueme Kingsley , Gommersall Lyndon , Hellawell Giles , Hunter-Campbell Paul , Kanda Swamy Gokul , Kotwal Sanjeev , Kumar Vivekanandan , Mak David , Mohee Amar , Nambirajan Thiagarajan , Ward Douglas G. , Kennish Steven J. , Catto James W.F. , Patel Prashant , James Nicholas D. ,   on behalf of the BladderPath Collaborative Group, Ward Douglas , Gordon Naheema , Pirrie Sarah , Magwaro Sophia , Pope Ann , Hughes Ana , Doyle Hiede , Cherian Jacob , Scarratt Lyndsay , Johnstone Dawn , Hadfield Denise , Slack Amy , Ekwueme Kingsley , Jones Amanda , Owen Bethan Wyn , Gommersall Lyndon , Kitchen Mark , Davies Michelle , Murali Vinodh , Hellawell Giles , Gurung Prasanna , Hunter-Campbell Paul , Cogley Lyn , Swamy Gokul Kanda , Turrell Ellen , Johnstonem Maria , Catto James W.F. , Kennish Steven , Noon Aidan P. , Cumberbatch Marcus G.K. , Rosario Derek J. , Goodwin Louise , Behennah Katharine , Salim Ferekh , Hussain Syed A. , Kotwal Sanjeev , Main Christopher , Kumar Vivekanandan , Harmer Mark , Mak David , Taylor Will , Rai Baljinder , Mohee Amar , Noweir Hosam A , Chea Houda , Nambirajan Thiagarajan , Patrick Nina , Arora Vandan , Jessica Huang Ya-Wen , Patel Prashant , Manandhar Amar , Henvey Rosie , Jefferson Kieran P. , Hewitt Davina , Blacker Anthony , MacDonald Donald , Harding James , Khan Yakhub , Omer Altan , Chan Andrew , Michael Diokno , James Nicholas D. , Sui Bernard , Shur Josh , Khoo Vincent 
Published: February 2025

PURPOSE
Transurethral resection of bladder tumor (TURBT) is the initial staging procedure for new bladder cancers (BCs). For muscle-invasive bladder cancers (MIBCs), TURBT may delay definitive treatment. We investigated whether definitive treatment can be expedited for MIBC using flexible cystoscopic biopsy and multiparametric magnetic resonance imaging (mpMRI) for initial staging.

PATIENTS AND METHODS
We conducted a prospective open-label, randomized study conducted within 17 UK hospitals (registered as ISRCTN 35296862). Participants with suspected new BC were randomly assigned 1:1 to TURBT-staged or mpMRI-staged care, with minimization factors of sex, age, and clinician visual assessment of stage. Blinding was not possible. Patients unable/unwilling to undergo mpMRI or with previous BC were ineligible. The study had two stages with separate primary outcomes of feasibility and time to correct treatment (TTCT) for MIBC, respectively.

RESULTS

Between May 31, 2018, and December 31, 2021, 638 patients were screened, and 143 participants randomly assigned to TURBT (n = 72; 55 males, 15 MIBCs) or initial mpMRI (n = 71; 53 males, 14 MIBCs). For feasibility, 36 of 39 (92% [95% CI, 79 to 98]) participants with suspected MIBC underwent mpMRI. The median TTCT for participants with MIBC was significantly shorter with initial mpMRI (n = 12, 53 days [95% CI, 20 to 89]
v
n = 14, 98 days [95% CI, 72 to 125] for TURBT, log-rank
P
.02). There was no detriment for participants with non-MIBC (median TTCT: n = 30, 17 days [95% CI, 8 to 25] for mpMRI
v
n = 28, 14 days [95% CI, 10 to 29] for TURBT, log-rank
P
= .67). No serious adverse events were reported.

CONCLUSION
The mpMRI-directed pathway led to a 45-day reduction in TTCT for MIBC. Incorporating mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected MIBC.