Integrating ctDNA Into Perioperative Management of MIBC

In this episode, “Integrating ctDNA Into Perioperative Management of MIBC,” the panelists explore how circulating tumor DNA (ctDNA) and other emerging biomarkers are influencing treatment decisions in muscle-invasive bladder cancer (MIBC). The expert urologic oncology faculty discuss how perioperative management has become increasingly individualized in the modern era, particularly as newer systemic therapies create more complex decisions surrounding surgical timing, treatment escalation, and postoperative management.

Throughout the discussion, the panel highlights the growing role of ctDNA in the postoperative and perioperative settings, including how ctDNA results may help identify patients at higher risk for recurrence following radical cystectomy. The faculty review emerging data from recent clinical trials and discuss how ctDNA may eventually support more personalized approaches to adjuvant therapy, treatment de-escalation, and surveillance strategies in MIBC.

The panelists also examine the limitations of relying on ctDNA alone and emphasize the importance of integrating biomarker results with surgical pathology, imaging findings, urinary biomarkers, and overall clinical context. In addition, the discussion explores how urinary tumor DNA and circulating tumor DNA may provide complementary information regarding local versus systemic disease burden.

Finally, the faculty emphasize that modern perioperative management of MIBC increasingly requires close multidisciplinary collaboration between urologists, medical oncologists, and radiation oncologists. The panel discusses how treatment decisions have become more dynamic and individualized as newer perioperative therapies, biomarkers, and sequencing strategies continue to evolve in clinical practice.

The next episode in this series, “Bladder Preservation and Biomarker Challenges in MIBC,” panelists will discuss the evolving role of MRI, ctDNA, and urinary tumor DNA in assessing treatment response and guiding bladder-sparing strategies in muscle-invasive bladder cancer. The panel will also highlight current limitations in identifying residual disease following perioperative therapy and the challenges associated with safely omitting radical cystectomy.