In patients with muscle-invasive bladder cancer, surgical removal of the bladder is often still the standard treatment. But is such an invasive, life-changing procedure always necessary? Researchers at UMC Utrecht are working towards a future in which treatments are increasingly tailored to the individual patient and in which some patients may be able to keep their bladder.
In muscle-invasive bladder cancer, microscopically small remnants of cancer may remain after surgery, or cancer cells may already be present in the blood or lymphatic vessels. These are often not yet visible on scans, but can later develop into metastases. Because clinicians currently cannot reliably predict which patients will have residual disease, bladder removal remains a necessary step for many.
Using circulating tumour DNA (ctDNA) — small fragments of DNA from tumour cells circulating in the bloodstream — and urine tumour DNA (utDNA), clinicians may be able to detect such minimal residual disease earlier and more accurately. In international studies involving researchers from UMC Utrecht, ctDNA and utDNA proved helpful in determining which patients need additional treatment and which do not. Ultimately, researchers hope this will enable more personalized treatment and, where possible, bladder preservation.
“We are constantly trying to better predict which patients will benefit from treatment and which will not,”
Bladder cancer research: what do international studies tell us?
In these studies, patients received ctDNA and utDNA tests regularly during and after neoadjuvant treatment with chemotherapy and/or immunotherapy. Only patients in whom tumour DNA was detected in the blood received additional treatment. This approach proved effective: it improved survival in patients at high risk of disease recurrence, while reducing unnecessary treatment and the burden on patients.
These findings are part of a broader shift towards increasingly tumour-specific treatments for bladder cancer. “We are constantly trying to better predict which patients will benefit from treatment and which will not,” says medical oncologist Britt Suelmann. “The ultimate goal is to treat patients as precisely as possible, with minimal side effects and maximum effectiveness.”
Bladder preservation: what does it mean for quality of life?
UMC Utrecht researchers are therefore also looking beyond post-operative treatment, focusing on treatment before surgery. “From the moment someone is diagnosed with muscle-invasive bladder cancer, we aim to achieve the highest possible response using combinations of immunotherapy and/or targeted therapy. At UMC Utrecht, patients have access to the latest combinations of immunotherapy and targeted therapy, rather than relying solely on chemotherapy,” explains Suelmann.
Suelmann and the uro-oncology team are also working on improving scan assessment after neoadjuvant treatment, enabling clinicians to better determine whether and to what extent, treatment has been effective. In the future, they hope to use AI-driven prediction models to develop a fully personalised treatment plan for each patient, tailored to the individual tumour.
The overarching goal is to make bladder-sparing treatment possible for more patients. “At this point, we cannot yet say with certainty which patients have no residual disease after treatment. But bladder-sparing treatment can offer significant benefits for quality of life. A cystectomy is a major procedure with lasting consequences.”
“Patients don’t have to repeat their story every time”
Integrated care: one contact throughout the entire treatment journey
Bladder cancer treatment often involves multiple specialists. According to nurse practitioner Bert van Rixtel, having a consistent point of contact is essential for patients. “At UMC Utrecht, each patient is assigned a nurse practitioner as their primary contact,” he explains. “Even when someone transitions from urology to medical oncology, I remain their contact person.
This also means patients never have to repeat their story. “Nothing is more frustrating than having to explain your situation over and over again. These patients already have enough to deal with. We know the patient, and we are involved in the decision-making around their treatment.”
Van Rixtel emphasises that the team looks beyond the disease itself. “With bladder cancer, there are often several treatment options. Together, we look at what fits best and what someone needs to get through treatment successfully.” Patients can also reach Van Rixtel directly when side effects arise. “That means we can act quickly when someone experiences symptoms. It helps patients stay on track with their treatment.”
