Patients with an aggressive form of bladder cancer could receive treatment in nearly half the time if a cheaper, less-invasive test is used, research has found.
Researchers from the University of Birmingham’s Bladder Cancer Research Centre and Cancer Research UK Clinical Trials Unit conducted a randomised controlled trial of 143 patients with suspected muscle-invasive bladder cancer, providing some cancer patients with initial diagnostic MRIs and others with the normal surgical test for bladder tumours.
In the research, published in the Journal of Clinical Oncology this month, the team found patients given the MRI, followed by a biopsy, had a significant reduction in the time taken to receive treatment. Those patients had a median wait time of 53 days from first referral to correct treatment, 45 days faster than the normal standard of care.
The standard test for muscle-invasive bladder cancer involves a surgical procedure performed under anaesthesia, where a thin telescope is inserted through the urethra to check the bladder and remove suspected tumour material.
Rik Bryan, professor in urothelial cancer research and director of the Bladder Cancer Research Centre at the University of Birmingham said the standard initial treatment pathway for bladder cancer has “remained essentially unchanged worldwide for over 100 years”.
He added: “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 six weeks to 53 days.”
Bladder cancer is the 11th most common cancer diagnosed in the UK, according to Cancer Research UK, with around 10,500 new cases diagnosed each year. The cancer is more common in men, and people aged 85-89.
While most patients develop a non-muscle-invasive form of the disease, 20 to 25 per cent of patients develop the more aggressive muscle-invasive type, which has a five-year survival rate of 27 to 50 per cent despite radical treatment. The researchers said women were frequently misdiagnosed.
Professor Bryan, who was the lead author of the study, said the research was important for improving the diagnosis and treatment of bladder cancer.
“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,” he said.
“Any way to improve the time from initially suspecting cancer to getting the right treatment gives patients the best chance of responding well.”
Nick James, professor of prostate and bladder cancer research at the Institute of Cancer Research in London and consultant clinical oncologist at The Royal Marsden NHS Foundation Trust - and the study’s chief investigator - said the team was also able to show about one in seven patients with “problematic tumours” were able to 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,” he said.
“The next step for this research is to assess whether this impacts the survival of these patients.”
Signs of bladder cancer
Blood in the urine is the most common symptom of bladder cancer. Cancer Research UK said about 80 per cent of patients with bladder cancer will have that symptom, which can come and go, and usually looks bright red when it occurs.
Other symptoms include needing to pass urine very often or very suddenly, and pain or a burning sensation when passing urine, but all those symptoms are much more likely to be caused by other conditions such as a urinary tract infection.
Signs that bladder cancer may have advanced include unexpected weight loss, feeling tired or unwell, and pain in the back, lower abdomen or bones.
