- Combining an imaging exam known as cystoscopy with a ctDNA blood test can help identify which patients still have cancer in their bladder after treatment and which may be cancer-free.
- Combining the tests was much more accurate than either test on its own.
- This approach could help urologists identify patients who could safely avoid life-altering bladder removal surgery.
PHILADELPHIA (February 26, 2026) — Combining a visual inspection of the bladder with a blood test to check for the presence of circulating tumor DNA can accurately predict which bladder cancer patients still have cancer in their bladder after treatment — and which do not. The findings presented today by Fox Chase Cancer Center researchers could someday help urologists identify which bladder cancer patients can safely avoid undergoing bladder removal, a risky and life-altering surgery.
“These results were even more striking than I expected,” said first author Matthew Zibelman, MD, Associate Professor in the Department of Hematology/Oncology and Director of Genitourinary Clinical Research at Fox Chase. “It suggests that using these approaches together will be much more powerful than visual inspection alone in predicting absence of disease.”
An Unmet Need for Better Prediction
Current standard of care is to treat patients with chemotherapy if they can tolerate it, then remove the bladder.
“But when we actually take it out, some of these patients don’t have any cancer left,” Zibelman said. “If we could know better beforehand who still had cancer and who didn’t, we could make more informed decisions about who might be able to safely avoid that big surgery in the first place.”
The new research builds on a previous study by Zibelman’s team in which surgeons performed an imaging exam known as cystoscopy to look for signs of cancer remaining in the bladder before surgery. This assessment missed clinically significant cancers around a quarter of the time.
For the new study, researchers tested blood samples taken from the patients on the day of surgery, looking for signs of circulating tumor DNA (ctDNA), which are tiny fragments of DNA released by cancer cells into the bloodstream. Their presence suggests residual cancer may exist somewhere in the body.
While other studies have looked at ctDNA in the blood compared to tissue samples from the patients’ tumor, the new study is the largest one to measure ctDNA in blood without requiring that tissue, which would be an easier and faster process for patients and providers.
Key Findings
- Combining approaches worked best. While the ctDNA test alone correctly identified 68% of patients with residual cancer, using both approaches together increased accuracy to 95%.
- The combined approach identified patients who were cancer-free. When both tests were negative, 83% of patients had no cancer remaining, compared to 48% accuracy with the imaging exam alone.
- Tests predicted long-term outcomes. Patients with negative ctDNA blood tests lived longer and had less cancer recurrence.
A Life-Altering Surgery
Bladder removal surgery, or cystectomy, is a major surgery with a long recovery time and risk of serious complications. It also has an enormous impact on quality of life, as patients may need to use a bag to collect urine for the rest of their lives.
Zibelman’s team has worked to find ways to treat bladder cancer with less risk and fewer impacts on patients.
“Our larger goal is ultimately to help patients feel confident about avoiding bladder removal surgery without compromising the long-term risk of recurrence and death from bladder cancer,” he said. Researchers are currently conducting a follow-up trial to better understand how the combined approach of cystoscopy and ctDNA tests can be used to guide clinical decisions.
The study, “Circulating Tumor DNA Analysis from the Prospective pT0 Study of Systematic Endoscopic Evaluation in Patients Undergoing Radical Cystectomy for Bladder Cancer,” was presented at the 2026 ASCO Genitourinary Cancers Symposium, which is being held February 26-28 in San Francisco.