URINE tumour DNA (utDNA) testing identified patients at increased risk of recurrence following bacillus Calmette-Guérin (BCG) treatment for high-risk non-muscle-invasive bladder cancer, according to a multicentre study.
The findings suggest that molecular testing could help identify recurrence earlier than standard clinical surveillance and potentially support more personalised treatment decisions.
Researchers analysed pretreatment and post-treatment urine samples from patients undergoing BCG for non-muscle-invasive bladder cancer. Samples were assessed using utDNA testing to classify molecular disease status and determine genomic disease burden.
Before the first BCG treatment, 23 of 57 patients (40%) tested positive for utDNA. Patients with positive results had a 12-month recurrence-free survival of 61%, compared with 85% among those who tested negative (hazard ratio: 3.2; p=0.04).
The researchers also assessed utDNA following BCG treatment. Among 43 patients who were clinically negative for disease after treatment, eight (19%) remained utDNA positive.
This group had substantially lower 12-month recurrence-free survival than patients who were utDNA negative: 25% compared with 91% (hazard ratio: 10.0; p<0.001).
These findings indicate that molecular evidence of residual or recurrent disease may identify patients at particularly high risk even when clinical surveillance does not yet detect recurrence.
Among patients who subsequently experienced recurrence, utDNA detected one-third of cases while clinical surveillance remained negative. Molecular detection provided a median lead time of 4.1 months before clinical diagnosis.
Of these lead-time cases, 67% subsequently underwent radical cystectomy, while 33% progressed to muscle-invasive disease.
The researchers concluded that utDNA testing could provide a means of stratifying recurrence risk in patients receiving BCG and detecting recurrence at an earlier stage. The findings also suggest potential for molecular monitoring to inform decisions around treatment intensification or de-escalation.
Further evaluation will be needed to determine how utDNA testing could be incorporated into clinical surveillance and whether earlier molecular detection can translate into improved outcomes for patients with high-risk non-muscle-invasive bladder cancer.
Reference
Fertitta L et al. Cherry angiomas in individuals with neurofibromatosis type 1. JAMA Dermatol. 2026;DOI:10.1001/jamadermatol.2026.2933.
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