Impact of Positron Emission Tomography (PET) Imaging in Muscle-invasive Urothelial Carcinoma of the Bladder Staging

  • End date
    Dec 31, 2024
  • participants needed
  • sponsor
    Ontario Clinical Oncology Group (OCOG)
Updated on 21 November 2021


Bladder cancer is the fifth most common cancer in Canada and there has been relatively little progress in altering its clinical course over the last three decades. One of the major problems identified in the management of this disease, is under staging of muscle invasive disease which can lead to suboptimal treatment and outcomes. PET-CT has the potential to more accurately stage MIBC than standard CT by detecting pelvic adenopathy and/or distant sites of disease that may not be found on standard imaging. In the former situation, more aggressive therapy with extended lymph node dissection and/or neoadjuvant chemotherapy prior to cystectomy can be offered. While in the latter situation patients can be spared the morbidity of a cystectomy performed in a setting of metastatic disease. This study will address whether PET-CT adds a clinically meaningful difference in care.


A multicenter randomized controlled trial will be performed. Patients usually present with symptoms (e.g., painless hematuria). The urologist will perform cystoscopy and if urothelial cancer of the bladder is suspected, the patient is taken to the operating room for an examination under anesthesia (EUA) and a TURBT. If this shows muscle invasion then conventional staging with CT chest, abdomen, and pelvis is performed. The patient who has TNM Stage T2a-T4a N0-3 M0 is eligible to be enrolled in the trial. Eligible consenting patients will be randomized 2:1 to PET-CT or none (Control). The actual treatment received by the patient will be documented. The primary outcome measure is treatment received.

Condition Muscle Invasive Bladder Cancer
Treatment Whole-body FDG PET-CT
Clinical Study IdentifierNCT02462239
SponsorOntario Clinical Oncology Group (OCOG)
Last Modified on21 November 2021


Yes No Not Sure

Inclusion Criteria

Men and women with newly diagnosed muscle-invasive high grade urothelial carcinoma of the bladder (TNM stage T2a-T4a, N0-3, M0), who are eligible for either radical cystectomy or radiotherapy-based bladder conservation
Being considered for treatment of curative intent

Exclusion Criteria

Age < 18 years
ECOG performance status >2\
Predominant histology (>50% of specimen) involves non-urothelial cell carcinoma
Prior partial cystectomy
Prior pelvis surgery that obviates a completed extended lymphadenectomy (e.g., aorto-femoral/iliac bypass) or for whom the surgeon feels that their ability to perform a standard or extended pelvic node dissection would be compromised
Contraindications to FDG PET-CT
Inability to lie supine for imaging with PET-CT
Inadequate hepatic function
(i) Bilirubin >1.5 X ULN and (ii) SGOT and Alkaline phosphatase >3 X ULN
History of another invasive malignancy within the previous 5 years with the exception of non-melanoma skin cancer
Known pregnancy or lactating female
Inability to complete the study or required follow-up
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