Patients with a common, aggressive type of bladder cancer could benefit from an initial MRI and biopsy investigation, according to a study published in the Journal of Clinical Oncology.
Researchers from the University of Birmingham’s Bladder Cancer Research Centre (BCRC) and Cancer Research UK Clinical Trials Unit (CRCTU) ran a randomised controlled trial testing whether multiparametric MRI (mpMRI) and a biopsy could improve treatment.
The team found that doing so as the first staging investigation was as effective and quicker than normal surgical staging for bladder tumours.
'Vastley reduced time taken'
Funded by the UK National Institute for Health and Care Research (NIHR), the study saw 143 patients with suspected bladder cancer split into two randomised groups, either going through the typical transurethral resection of bladder tumour (TURBT) process, or mpMRI to decide next steps.
Patients randomised to receive mpMRI had a significant reduction in time taken to receive correct treatment – a median time of 53 days from first referral to correct treatment, 45 days less than the standard median of 98 days.
ProfessorRik Bryan, professor of Urothelial Cancer Research and director of the Bladder Cancer Research Centre at the University of Birmingham, first author of the study, said: “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 ... by more than six weeks.”
'Speed is of the essence'
Transurethral resection 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.
Multiparametric MRI combines several different MRI techniques into a single scan session to produce a much more detailed image.
Bryan went on to explain bladder cancer is a common form of cancer, and that “speed is of the essence” during treatment.
He continued: “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.”
Saving money and space
Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, consultant clinical oncologist at the Royal Marsden NHS Foundation Trust and the study chief investigator, explained that the trial found around one in seven patients with problematic tumours can avoid the surgery used to diagnose bladder cancer entirely.
“As an MRI is considerably cheaper than this surgery, we estimate that this new diagnostic pathway will save money," he said, "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.”
The full study can be found online here.
(Image: Professor Rik Bryan, via the University of Birmingham)