A trial to improve diagnosing bladder cancer (BladderPath Trial)

Cancer type:

Bladder cancer

Status:

Results

Phase:

Phase 2

This trial looked at using an mpMRI scan to diagnose bladder cancer that had grown into the muscle. This is muscle invasive bladder cancer.

It was open for people to join between 2018 and 2021. The team published the results in 2025.

More about this trial

There are several tests to diagnose suspected bladder cancer. One test uses a camera to look inside the bladder. This is a cystoscopy. At the time of this trial, the next step was to have a trans urethral resection of bladder tumour (TURBT). This involves removing the area of cancer. Doctors use this to work out whether the cancer has grown into the muscle wall of the bladder or not.

Doctors were worried that waiting to have a TURBT to stage Open a glossary item muscle invasive bladder cancer delayed treatment. So researchers were looking for quicker ways to diagnose and stage it.

In this trial, they looked at a type of MRI scan called multiparametric MRI (mpMRI). It is a special type of MRI scan that produces a more detailed picture than a standard MRI scan does.

Everyone in the trial had a cystoscopy as usual and a small tissue sample (biopsy Open a glossary item ) was taken if possible. The doctor’s visual examination during the cystoscopy helped with the initial diagnosis. If it wasn’t possible to take a sample, people thought to have possible muscle invasive bladder cancer either had a 2nd cystoscopy or a TURBT.

Everyone in the trial was then put into 1 of 2 groups at random:

half had the standard way of diagnosing bladder cancer which involved a TURBT. This was pathway 1.
half had the newer way of diagnosing bladder cancer. This was pathway 2.

People in pathway 2 were then divided into those who:

probably didn’t have cancer in the muscle. They had a standard TURBT test.
might have cancer that had grown into the muscle. They had an mpMRI scan of the bladder.

The main aims of the trial were to find out:

how accurate mpMRI scans are at diagnosing muscle invasive bladder cancer
if the scan reduces treatment waiting times for people with muscle invasive bladder cancer
if the scan avoids unnecessary surgery

Summary of results

143 people joined this trial in total. 140 people were put into a pathway. There were:

72 people in pathway 1. They had a trans urethral resection of bladder tumour (TURBT).
68 people in pathway 2. They had a TURBT or an mpMRI scan.

In pathway 2:

32 people probably didn’t have cancer in the muscle wall of the bladder. They had a TURBT.
36 people might have had cancer in the muscle wall. They had an mpMRI scan of the bladder. They only had a TURBT if their doctor thought it was necessary.

Results for people who had muscle invasive bladder cancer (MIBC)
In the trial, there were 31 people who were assessed and confirmed as having MIBC. This was:

14 people in pathway 1 (the standard pathway)
17 people in pathway 2

The team looked at how long it took for these 31 people to have the correct treatment. This treatment could have included any of the following:

chemotherapy
surgery to remove the bladder (a cystectomy)
palliative care
radiotherapy
a TURBT

In pathway 1, it was 98 days from first being referred to hospital for tests to having the correct treatment.

In pathway 2, it was 53 days from first being referred to hospital for tests to having the correct treatment.

In pathway 2, there were another 3 people who had an mpMRI but it wasn’t possible to draw firm conclusions from their scans.

Results for people who had non muscle invasive bladder cancer (NMIBC)
There were 101 people in the trial who had a TURBT. Of those confirmed as having NMIBC, there were:

50 people in pathway 1
30 people in pathway 2

Of the people who had mpMRI in pathway 2, they found that 16 people had NMIBC.

The team wanted to make sure that the different pathways didn’t affect the time to treatment for NMIBC. They looked at the time to correct treatment for this group of people. They found there was no difference between the different pathways.

Conclusion
The trial team concluded that having an mpMRI scan ahead of a TURBT was useful. The mpMRI scan helped everyone with suspected muscle invasive bladder cancer. It was possible to skip the TURBT if their doctor decided they could. And the time to correct treatment was much quicker than those who had a TURBT. It was 45 days less with the mpMRI scan.

The trial team think that introducing the mpMRI scan as part of routine care is likely to be quite easy. This would be for people with suspected MIBC.

More detailed information
There is more information about this research in the reference below.

Please note, the information we link to here is not in plain English. It has been written for healthcare professionals and researchers.

Randomized Comparison of Magnetic Resonance Imaging Versus Transurethral Resection for Staging New Bladder Cancers: Results From the Prospective BladderPath Trial
R Bryan
Journal of Clinical Oncology, 2025. Available online 14th January 2025

Where this information comes from
We have based this summary on the information in the article above. This has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the link we list above is active and the article is free and available to view.