# Urine tumour DNA to replace surveillance cystoscopy in NMIBC

Source: https://onco.cc/ideas/idea-urine-ctdna-surveillance/  
OnCo record `idea-urine-ctdna-surveillance` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Bladder cancer sheds tumour DNA straight into urine. A urine test every few months could replace part of the surveillance cystoscopy schedule that patients with non-muscle-invasive bladder cancer follow for years, doubling the interval between camera examinations when the test is negative.

## Summary

Bladder cancer sheds tumour DNA directly into urine, and this idea proposes a urine test to replace part of the surveillance cystoscopy schedule that patients with non-muscle-invasive bladder cancer follow for years. Assays such as UroAmp, Bladder EpiCheck, Cxbladder and methylation panels detect recurrence with sensitivity approaching cystoscopy and can anticipate it by months. The rationale is that urine carries a far higher tumour DNA fraction than plasma, and that cystoscopy burden and cost make bladder cancer the most expensive cancer per patient. The hypothesis is that a negative urine test allows cystoscopy intervals to be doubled in intermediate-risk disease without more progression, tested in a randomised trial against fixed-interval cystoscopy, at an early clinical stage.

## Fields

- Kind: Idea
- Last checked: 2026-09-07
- Hypothesis: A negative urine tumour DNA test allows cystoscopy intervals to be doubled in intermediate-risk NMIBC without an increase in progression to MIBC.
- Rationale: Urine has far higher tumour DNA fraction than plasma for bladder cancer; cystoscopy burden and cost are the main drivers of bladder cancer's status as the most expensive cancer per patient.
- Proposed test: Randomised trial of urine-guided vs fixed-interval cystoscopy with progression as primary endpoint and quality of life secondary.
- Maturity: early-clinical

## Sources

- Dudley et al., Detection and surveillance of bladder cancer using urine tumour DNA (Cancer Discovery 2019): https://doi.org/10.1158/2159-8290.CD-18-0825

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/)
- technologies: [Bladder EpiCheck urine methylation test](https://onco.cc/technologies/bladder-epicheck/), [Cystoscopy, blue-light imaging & TURBT](https://onco.cc/technologies/cystoscopy-turbt/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [Urine tests for bladder cancer (cytology, FISH, RNA and methylation)](https://onco.cc/technologies/urine-bladder-cancer-tests/)
- key papers: [Detection and Surveillance of Bladder Cancer Using Urine Tumor DNA](https://onco.cc/key-papers/paper-dudley-cancer-discov/)

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