A new study shows that ultrasensitive blood and urine testing can help identify patients with muscle-invasive bladder cancer (MIBC) who may safely avoid radical cystectomy. This “liquid biopsy” approach detects tiny traces of cancer that standard scans miss, enabling personalized, bladder-preserving care instead of a one-size-fits-all surgery approach.
The study used two types of DNA tests: ctDNA from blood, which predicts the risk of cancer spreading to other organs, and utDNA from urine, which detects residual cancer in the bladder. Patients with undetectable ctDNA had only a 4.5% risk of metastatic disease, while detectable utDNA—even when scans appeared normal—was linked to higher risk of local recurrence.
For patients who achieved a complete clinical response, the 3-year bladder-intact survival was 69%. Those with undetectable DNA in both blood and urine represent a very low-risk group who could safely skip surgery, preserving quality of life and avoiding the complications of bladder removal. This approach allows doctors to tailor treatment based on individual molecular risk rather than treating everyone the same.