Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jun 8;17(12):1908.
doi: 10.3390/cancers17121908.

Circulating Tumor DNA in Muscle-Invasive Bladder Cancer: Implications for Prognosis and Treatment Personalization

Stamatios Katsimperis  1 , Lazaros Tzelves  1 , Georgios Feretzakis  2 , Themistoklis Bellos  1 , Ioannis Tsikopoulos  3 , Nikolaos Kostakopoulos  4 , Andreas Skolarikos  1
Affiliations
Review

Circulating Tumor DNA in Muscle-Invasive Bladder Cancer: Implications for Prognosis and Treatment Personalization

Stamatios Katsimperis et al. Cancers (Basel). .

Abstract

Muscle-invasive bladder cancer (MIBC) is a biologically aggressive disease with high recurrence rates, despite advances in surgical and systemic therapies. Circulating tumor DNA (ctDNA), a tumor-specific fraction of cell-free DNA, has emerged as a promising non-invasive biomarker for the real-time assessment of tumor burden, treatment response, and minimal residual disease (MRD). This review explores the biological basis, detection technologies, and clinical utility of ctDNA in MIBC, highlighting its role in preoperative risk stratification, postoperative surveillance, and personalized decision-making for adjuvant and systemic therapies. We critically examine current evidence from pivotal trials and ongoing studies that support ctDNA's prognostic and predictive value. Additionally, we discuss emerging applications, including ctDNA-guided immunotherapy, integration with imaging and molecular data, and potential to inform bladder-sparing strategies. While ctDNA presents technical and logistical challenges, its incorporation into prospective clinical workflows promises to enhance precision oncology and improve outcomes in patients with MIBC.

Keywords: adjuvant immunotherapy; biomarkers; bladder cancer surveillance; cell-free DNA; circulating tumor DNA; liquid biopsy; molecular diagnostics; muscle-invasive bladder cancer; precision oncology; risk stratification; treatment personalization; tumor-informed assays; urothelial carcinoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Powles T., Bellmunt J., Comperat E., De Santis M., Huddart R., Loriot Y., Necchi A., Valderrama B.P., Ravaud A., Shariat S.F., et al. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann. Oncol. 2022;33:244–258. doi: 10.1016/j.annonc.2021.11.012. - DOI - PubMed
    1. Chang S.S., Bochner B.H., Chou R., Dreicer R., Kamat A.M., Lerner S.P., Lotan Y., Meeks J.J., Michalski J.M., Morgan T.M., et al. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. J. Urol. 2017;198:552–559. doi: 10.1016/j.juro.2017.04.086. - DOI - PMC - PubMed
    1. van der Heijden A.G., Bruins H.M., Carrion A., Cathomas R., Compérat E., Dimitropoulos K., Efstathiou J.A., Fietkau R., Kailavasan M., Lorch A., et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2025 Guidelines. Eur. Urol. 2025;87:582–600. doi: 10.1016/j.eururo.2025.02.019. - DOI - PubMed
    1. Yin M., Joshi M., Meijer R.P., Glantz M., Holder S., Harvey H.A., Kaag M., Fransen van de Putte E.E., Horenblas S., Drabick J.J. Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Systematic Review and Two-Step Meta-Analysis. Oncologist. 2016;21:708–715. doi: 10.1634/theoncologist.2015-0440. - DOI - PMC - PubMed
    1. Rose K.M., Huelster H.L., Meeks J.J., Faltas B.M., Sonpavde G.P., Lerner S.P., Ross J.S., Spiess P.E., Grass G.D., Jain R.K., et al. Circulating and urinary tumour DNA in urothelial carcinoma—Upper tract, lower tract and metastatic disease. Nat. Rev. Urol. 2023;20:406–419. doi: 10.1038/s41585-023-00725-2. - DOI - PubMed

LinkOut - more resources