Risk Stratification and Surveillance After

In this segment, Dr. Thomas Powles introduced the discussion on ctDNA-based molecular residual disease (MRD) testing in muscle-invasive bladder cancer (MIBC), framing it within the context of relapse risk after cystectomy. He emphasized that metastatic progression—not local recurrence—is the key driver of mortality, highlighting the need for systemic therapies that target metastatic disease. High-risk features such as advanced T stage, high-grade histology, carcinoma in situ, and variant subtypes were reviewed, along with the prognostic value of pathologic complete response following neoadjuvant therapy. Dr. Powles noted that most relapses occur within two years, often within months for ctDNA-positive patients. The panel expanded on systemic therapy advances, including immunotherapy, antibody-drug conjugates (EV Pembro), and targeted agents (erdafitinib), emphasizing how these are reshaping perioperative management. The discussion underscored how ctDNA testing could refine risk stratification and therapeutic intensity in the evolving treatment paradigm for MIBC.