Christopher Filson, MD, on using CxBladder Triage to risk-align cystoscopy in microhematuria

In this video, Christopher P. Filson, MD, MS, highlights the background and key findings from a study evaluating the real-world utility of incorporating the CxBladder Triage test to the diagnostic workflow for microhematuria.¹ According to the authors, CxBladder Triage is “a urine-based biomarker of mRNA targets and clinical factors to assess urothelial cancer risk.”

Filson is a urologic oncologist at Kaiser Permanente and a professor of clinical science at the Bernard J. Tyson Kaiser Permanente School of Medicine in Los Angeles, California.

Filson explains that even with recent shifts in guideline recommendations, many patients who present with microhematuria undergo cystoscopy with little cancer detection. That need led to the development of the CxBladder Triage test, which can help identify patients who are at a higher risk of cancer detection so that patients at lower risk can avoid these often costly and invasive procedures. The test has been assessed in other trials, showing value in risk stratifying these patients. The current study sought to assess its effectiveness in a large integrative health system like Kaiser Permanente.

In total, the retrospective matched cohort study matched 3353 patients tested with CxBladder Triage with 3353 controls. Among those in the CxBladder cohort, 79.6% had a low probability of cancer. These patients were less likely to undergo cystoscopy, with 3.8% of patients with a low-risk score receiving the procedure vs 46.5% of patients in the control arm (P < .001). Further, patients with a higher risk of cancer were more likely to undergo cystoscopy compared with those in the control arm (73.4% vs 45.7% controls; P < .001).

Data also showed similar cancer detection rates between both cohorts, with a rate of 0.3% in the CxBladder arm vs 0.6% in the control arm (P = .105).

Filson concluded, “All in all, if you group those together, cystoscopy use dropped 20% among the patients who were tested, suggesting that not only did we more properly risk align cystoscopy use, but over-utilization dropped overall. So, it was a win-win.”

REFERENCE

1. Filson CP, Slezak JM, Luong TQ, Aboushwareb T, Loo RK.
Real-World Utility of Cxbladder Triage for Patients with Microhematuria: A Matched Cohort Study. Urol Pract. 2026 Jan 20:101097UPJ0000000000000972. doi:10.1097/UPJ.0000000000000972