MRI-based assessment may eliminate the need for transurethral resection of bladder tumor (TURBT) in patients with suspected muscle-invasive bladder cancer (MIBC), according to research presented at ESMO Congress 2022.

Assessing suspected bladder cancer via flexible cystoscopy and MRI shortened the time to correct treatment, when compared with TURBT, for patients with MIBC in the BladderPath trial. 

“We would conclude that patients with obvious muscle-invasive disease can potentially be spared a TURBT,” said study presenter Nicholas James, MBBS, PhD, of the Institute of Cancer Research in London.

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For this trial, Dr James and colleagues evaluated 143 patients with suspected bladder cancer. At baseline, 75.5% of patients were men, 67.8% were younger than 75 years of age, and 53.8% had possible MIBC, according to initial clinical assessment.

Pathway Details

Patients were randomly assigned to 1 of 2 pathways. In pathway 1 (n=72), patients with possible MIBC or probable non-muscle invasive bladder cancer (NMIBC) were assigned to TURBT. After TURBT, patients with NMIBC received adjuvant therapy, which was considered correct treatment. Patients with MIBC received chemotherapy, radiotherapy (RT), surgery, or palliative care, all of which were considered correct treatment for this group. 

In pathway 2 (n=71), patients proceeded to MRI or TURBT based on an initial clinical assessment following flexible cystoscopy, using a Likert scale to estimate probable NMIBC and possible MBIC. Patients with possible MBIC were assigned to MRI, and those with probable NMIBC were assigned to TURBT. 

Among patients who underwent TURBT in pathway 2, those found to have NMIBC proceeded to adjuvant therapy (correct treatment), and those found to have MIBC proceeded to chemotherapy, RT, surgery, or palliative care (correct treatment). 

Among patients who underwent MRI in pathway 2, those found to have MIBC went on to receive correct treatment. The patients thought to have NMIBC proceeded to TURBT, which was followed by correct treatment according to diagnosis (adjuvant treatment for NMBIC and 1 of the 4 options for MIBC).


The primary endpoint was time to correct treatment for patient with confirmed MIBC, and a secondary endpoint was time to correct treatment for all patients.

MRI-guided assessment resulted in a significantly shorter time to correct treatment for patients with MIBC. The median time to correct treatment was 53 days with MRI and 98 days with TURBT (hazard ratio, 3.4; 95% CI, 1.4-8.3; P =.0046). 

“The image-directed pathway, as we hoped, substantially accelerated the time to definitive treatment for patients with suspected muscle-invasive disease,” Dr James said. “[U]sing a Likert scale allowed us to identify the patients who are most likely to benefit from having the MRI scan.”

“There was no adverse effect on time to treatment for the non-invasive patients,” he added. “In fact, if anything, it was also accelerated.” 

The median to correct treatment for all patients was 37 days with pathway 1 and 31 days with pathway 2.


James ND, Pirrie S, Liu W, et al. First results from BladderPath: A randomised trial of MRI versus cystoscopic staging for newly diagnosed bladder cancer. Presented at ESMO 2022; September 9-13, 2022. Abstract 1733MO.