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Thomas Flaig, MD


Is More Imaging Better? PET’s Impact on Treatment of Muscle-Invasive Bladder Cancer

By: Celeste L. Dixon
Posted: Wednesday, November 29, 2023

The results of PET-MUSE, a randomized study involving 292 patients newly diagnosed with muscle-invasive bladder cancer, have shown that adding 18F-FDG PET/CT to standard staging with baseline CT imaging showed a nonstatistically significant trend toward changes in staging and disease management. The primary outcome was the proportion of patients not receiving expected treatment, said Srikala Sridhar, MD, MSc, FRCPC, of Princess Margaret Cancer Centre, Toronto, and colleagues in their work presented at the European Society for Medical Oncology (ESMO) Congress 2023 (Abstract 2361MO).

Enrolled in 2021 at six Ontario medical centers, all patients had predominant urothelial histology and no metastases on baseline CT, and their disease was T2a–T4 and N0–3. They were randomly assigned 2:1 to PET/CT (n = 194) or no further imaging (n = 98). CT imaging is critical to making decisions about neoadjuvant chemotherapy and about local treatment with either radical cystectomy or chemoradiation, but “it can often underestimate disease extent,” explained the team.

After a median follow-up of 2 years, in the PET/CT and no-PET/CT arms, respectively, 77% and 77% of patients had T2 disease; 88% and 87% had node-negative disease; 66% and 69% had planned radical cystectomy; and 70% and 64% had planned neoadjuvant chemotherapy. The patients’ median age was 70 and 68 years, respectively.

Patients receiving PET/CT, compared with those receiving CT alone, were more likely to have a change in treatment (odds ratio = 2.89; P = .06). In the PET/CT and no-PET/CT arms, respectively, 86% and 92% of patients received expected treatment, 11% and 4% did not, and 4% and 4% withdrew or died prior to treatment. No statistically significant differences were observed between arms for disease-free survival or overall survival, the secondary outcomes. Nonetheless, the team concluded, “This trial provides new insights into the clinical utility of PET/CT in muscle-invasive bladder cancer.”

Disclosure: The study authors’ disclosure information can be found at

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