(UroToday.com) The 2026 European Association of Urology (EAU) annual meeting featured a cutting-edge strategies in bladder cancer session and a presentation by Dr. James Catto discussing the final survival analysis from the BladderPath trial comparing MRI versus transurethral resection for staging new bladder cancers. TURBT has been the mainstay of bladder cancer staging for > 60 years. Additionally, staging inaccuracies are often commonplace, leading to delayed treatment of muscle invasive bladder cancer (up to ~100 days from the outpatient appointment to the receipt of correct therapy). Multiparametric MRI offers rapid, accurate, and a non-invasive staging of muscle invasive bladder cancer.
BladderPath was an open-label, multistage randomized controlled study in 15 sites in three parts: feasibility, intermediate, and final clinical stages. Dr. Catto and colleagues previously reported that upfront MRI speeds time to definitive treatment for muscle invasive bladder cancer: a median 98 days on standard pathway versus 53 days with upfront MRI.1,2 At EAU 2026, Dr. Catto reported additional analysis of the mature 2 year outcomes for all patients. Newly presenting patients with a bladder mass at flexible cystoscopy referred for TURBT were randomized to Pathway 1 TURBT or Pathway 2 initial MRI for patients with possible muscle invasive bladder cancer (about 50% of the total patients), and subsequent therapy was determined by local practice. Trial data were merged with NHS Digital records to provide death and progression information. The endpoint for the final stage of BladderPath was progression free and overall survival.
Between May 31, 2018, and December 31, 2021, 143 participants were randomized. Initially, the trial aimed to test biopsy in place of TURBT; however, subsequent therapy could include TURBT, which occurred in 83% patients (main reasons: staging uncertainty, debulking, assess variant histology), hence this is an important additional outcome. Failure events were seen in 48% patients, including 54% Pathway 1 and 42% Pathway 2, with a failure free survival hazard ratio of 0.75 (95% CI 0.46, 1.22; p = 0.249):
The failure free survival when stratified by non muscle invasive bladder cancer and muscle invasive bladder cancer is highlighted in the following figure:
In terms of bladder cancer specific survival, there was a statistical benefit for MRI guided versus standard of care management (HR 0.36, 95% CI 0.135, 0.98; p = 0.046), driven by early separation of deaths for muscle invasive bladder cancer:
There was no difference in overall survival between the two cohorts (HR 0.67, 95% CI 0.34, 1.33; p = 0.252):
Causes of death are shown in the following table, noting a marked imbalance in bladder cancer death, and well balanced non-bladder causes of death:
Dr. Catto concluded his presentation discussing the final survival analysis from the BladderPath trial comparing MRI versus transurethral resection for staging new bladder cancers with the following take-home points:
- There was a strong trend to improvement in all key trial metrics, favoring an MRI guided pathway
- There was no evidence of detriment on outcomes from an MRI based pathway
- There was a notable statistically significant improvement in bladder cancer specific survival, favoring the MRI guided pathway
Presented by: James Catto, PhD, Professor, University of Sheffield, Sheffield, United Kingdom
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2026 European Association of Urology (EAU) Annual Meeting, London, United Kingdom, Fri, Mar 13 – Mon, Mar 16, 2026.