Urine tumour DNA to replace surveillance cystoscopy in NMIBC

Bladder cancer sheds tumour DNA directly into urine, and this idea proposes a urine test to replace part of the surveillance cystoscopy schedule that patients with non-muscle-invasive bladder cancer follow for years. Assays such as UroAmp, Bladder EpiCheck, Cxbladder and methylation panels detect recurrence with sensitivity approaching cystoscopy and can anticipate it by months. The rationale is that urine carries a far higher tumour DNA fraction than plasma, and that cystoscopy burden and cost make bladder cancer the most expensive cancer per patient. The hypothesis is that a negative urine test allows cystoscopy intervals to be doubled in intermediate-risk disease without more progression, tested in a randomised trial against fixed-interval cystoscopy, at an early clinical stage.