Patients with a common aggressive type of bladder cancer could get correct treatment significantly quicker as new research suggests that initial MRI imaging and biopsy could be used to reduce the time patients wait.
In a new study published in the Journal of Clinical Oncology, a research team led by Professor Nick James of The Institute of Cancer Research, London, and from the University of Birmingham’s Bladder Cancer Research Centre (BCRC) and Cancer Research UK Clinical Trials Unit (CRCTU) ran a randomised controlled trial. The trial tested whether adding a type of magnetic resonance imaging (mpMRI) as the first staging investigation was as effective and quicker than the usual surgical staging for bladder tumours.
TURBT compared with MRI
The study, funded by the UK National Institute for Health and Care Research, saw 143 patients with suspected bladder cancer randomised into two groups, either going through the usual test called transurethral resection of bladder tumour (TURBT), or an initial MRI scan to decide upon the most appropriate next steps.
The team found that patients who were randomised to have MRI had a significant reduction in the time taken to receive their correct treatment with a median time of 53 days from first referral to correct treatment, which was 45 days quicker than the usual standard of care which had a median time of 98 days.
'Speed is of the essence when treating'
Usual tests for muscle invasive bladder cancer involve transurethral resection, which is a surgical procedure carried out under anaesthetic by a surgeon in which a thin telescope inserted through the urethra is used to examine the bladder and remove tumour material.
Rik Bryan, Professor in Urothelial Cancer Research and Director of the Bladder Cancer Research Centre at the University of Birmingham and first author of the study said:
“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. Any ways to improve the time from initially suspecting cancer to getting the right treatment gives patients the best chance of responding well.
“However, this aspect of the bladder cancer care pathway has remained essentially unchanged worldwide for over 100 years, whilst the rest of medicine and healthcare has innovated around it. We wanted to evaluate whether the 21st century approaches that have benefited the diagnosis and treatment of all other cancer patients would also benefit bladder cancer patients. The BladderPath trial looked at whether adding in some extra or alternative diagnostic testing, mpMRI first then and biopsy or TURBT, could speed up the time taken to receive the correct treatment for the most concerning form of bladder cancer.
“We were delighted that the experimental diagnostic pathway that introduced MRI led to a vastly reduced time taken for patients to receive their correct treatments, from 98 days on average for the usual procedures reduced by more than 6 weeks to 53 days.”
Avoid surgical procedures
Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, and the study Chief Investigator said:
“This research shows that by adding an MRI pre-biopsy we can cut the time taken to correct treatment for the worst bladder tumours – those that invade the bladder muscle wall – by almost half, from 98 days down to 53 days. We’ve also shown that around 1 in 7 of these patients with problematic tumours can avoid the surgical procedure used to diagnose bladder cancer. As an MRI is considerably cheaper than this surgery, we estimate that this new diagnostic pathway will save money, as well as saving surgical theatre space and preventing patients from undergoing unnecessary procedures. The next step for this research is to assess whether this impacts the survival of these patients."