RNA urine test outperforms standard bladder cancer diagnostics and guides treatment choices

A new urine test developed by Stanford Medicine and VA Palo Alto researchers diagnoses bladder cancer more accurately than current standard methods, and can also predict whether immunotherapy or chemotherapy will be most effective for each patient. The test measures RNA messages shed by tumor cells, capturing cancer's behavior, not just its presence. In a study of 683 urine samples, the test correctly identified 95% of localized bladder cancer cases and correctly classified 90% of those without it, outperforming standard urine cytology and DNA-based tests. It also detected residual disease after surgery and predicted patient response to BCG immunotherapy based on pre-treatment RNA signatures of immune activity versus rapid tumor cell division. Bladder cancer affects about 85,000 Americans annually and is monitored via invasive cystoscopy, which can miss up to 30% of cases. The test could help ration scarce BCG supplies by identifying likely responders, and the researchers plan to validate the approach in larger, prospective multi-center trials.