Laura Bukavina, MD, MPH

Testing Advanced Tools To Identify Bladder Cancer Patients Who May Safely Avoid Surgery

Muscle‑invasive bladder cancer is a serious, fast‑growing form of bladder cancer. The standard treatment is to remove the bladder, often after a prolonged course of chemotherapy. The challenge is that current pre‑surgery tests, including scans, scopes and small biopsies, cannot always show whether dangerous cancer is truly gone. Even when the bladder looks clear, up to half of patients still have cancer hiding in the bladder wall.

At the same time, newer treatments like modern chemotherapy combinations, radiation and drug‑delivery devices paired with immunotherapy are helping more patients achieve what looks like a complete response. These advances make it more realistic for some people to keep their bladder, but only if we can be certain the cancer has truly been eliminated.

Led by Laura Bukavina, MD, MPH, the REFINE‑BC study will evaluate a practical combination of tools designed to detect whether any bladder cancer remains after treatment. The approach includes bladder MRI, a blood test that looks for tiny fragments of tumor DNA, a urine test that detects tumor DNA shed into the urine and a thorough bladder exam with targeted and random biopsies performed just before bladder‑removal surgery.

The study aims to determine whether combining these tests can accurately show when the cancer is truly gone. Currently, the only way to be certain is to examine the bladder under a microscope after it has been removed. For this reason, the test results will be compared with the findings from the final pathology. If the tests prove accurate, clinicians will be able to identify patients who may be able to safely keep their bladder and tailor treatment with much greater confidence.