ctDNA in Chemoradiotherapy and Bladder Preservation

Panelists explore the role of ctDNA in patients undergoing bladder-preserving approaches, particularly chemoradiotherapy. Emerging data suggest that ctDNA positivity before or after treatment is associated with worse metastasis-free survival, reinforcing its prognostic significance. However, its role in guiding treatment selection, such as choosing between cystectomy and chemoradiation, remains unclear. Clinicians describe using ctDNA primarily to identify patients at higher risk of systemic recurrence rather than to dictate local treatment decisions. The segment also highlights ongoing research evaluating how ctDNA may inform the integration of systemic therapies, including immunotherapy, into bladder preservation strategies. As bladder-sparing approaches gain traction, ctDNA may become an important tool for refining patient selection and monitoring response, though prospective validation is still needed.