ClinicalTrials.gg
Active, not recruitingNCT03933826CISTOUpdated May 12, 2026Results posted

CISTO: Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer

An observational study in Bladder Cancer, Cancer of the Bladder, Recurrent and Non-muscle Invasive Bladder Cancer, sponsored by University of Washington. Active, not recruiting at 36 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-05-12.

Primary conditionNon-Muscle Invasive Bladder NeoplasmsRegistry: Urinary Bladder NeoplasmsReclassifiedWhy we changed it
Registry
Urinary Bladder Neoplasms — the first condition term the registry derived for this study.
ClinicalTrials.gg
Non-Muscle Invasive Bladder Neoplasms
Why
  1. The study's listed conditions name Non-Muscle Invasive Bladder Neoplasms, a narrower term within Urinary Bladder Neoplasms.
Confidence
High: the new condition is named in the study's own listed conditions. Of 351 hand-checked studies reclassified this way, 68% were exactly right and 84% in the right disease family; the registry's first term was right for 5% (measured 2026-10-21). How we classify →
Wrong?
Tell us the study's main condition →

Sponsored by University of Washington · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
570
Ages
18 Years and older
Sex
All
01

Study summary

Bladder cancer is the most common urinary tract cancer and the 5th most common cancer in the US (1). Yet bladder cancer research is underfunded relative to other common cancers. As a result, bladder cancer care is prone to evidence gaps that produce decision uncertainty for both patients and clinicians. The Comparison of Intravesical Therapy and Surgery as Treatment Options (CISTO) for Bladder Cancer Study has the potential to fill these critical evidence gaps, change care pathways for the management of non-muscle-invasive bladder cancer (NMIBC), and provide for personalized, patient-centered care. The purpose of CISTO is to conduct a large prospective study that directly compares the impact of medical management versus bladder removal in recurrent high-grade NMIBC patients with Bacillus Calmette-Guerin (BCG) failure on clinical outcomes and patient and caregiver experience using standardized patient-reported outcomes (PROs).

Read the detailed description

Most bladder cancer patients (74%) present with NMIBC where the cancer is limited to the lining or support layer of the bladder. High-grade NMIBC is treated initially with endoscopic resection and intravesical immunotherapy, followed by bladder instillations of BCG. Most patients with high-risk, high-grade NMIBC are able to retain their bladders and avoid more invasive treatments. However, 24-61% of patients will have their cancers recur within 12 months of treatment with BCG (BCG failures), and they have limited treatment options. National guidelines recommend consideration between two alternatives: additional medical management and radical cystectomy (removal of the bladder). Selecting between these options involves weighing the risk of progression of bladder cancer and loss of a window of potential cure versus the risk of morbidity and loss of quality of life (QOL) with bladder removal. This complex decision-making engages patients and their caregivers, who may be impacted by the urinary, sexual, and bowel dysfunctions that can occur with NMIBC treatment.

The investigators will evaluate this research question on a large scale in real world practice settings including academic and community-based practices and examine patient-centered outcomes. The investigators have engaged stakeholders with diverse perspectives relevant to this research question, including patients, caregivers, national patient advocacy organizations, national medical specialty organizations, guideline developers, health care payers, and industry. By engaging broad expertise relevant to this research question, the investigators will ensure that the study results will help NMIBC patients whose cancer recurs after BCG treatment make more informed decisions that improve the health outcomes that are important to them.

CISTO is an observational study that will not affect the treatment that patients chose. Patient surveys will occur at study entry and at follow-up assessments for up to four years. There will also be a qualitative sub-study that will include interviews of approximately 50 patients and 25 caregivers recruited from the observational cohort study.

02

Conditions studied

  • Bladder Cancer
  • Cancer of the Bladder, Recurrent
  • Non-muscle Invasive Bladder Cancer

Keywords

  • pragmatic trial
  • Bacillus Calmette-Guerin (BCG)
  • urinary bladder neoplasms
  • urogenital neoplasms
  • radical cystectomy
  • neoplasms by site
  • neoplasms
  • urinary bladder disease
  • immunologic factors
  • caregivers
  • physiological effects of drugs
  • immunologic adjuvants
  • urologic diseases
03

In context

Non-Muscle Invasive Bladder Neoplasms Reclassified

294 studies on the registry are indexed under Non-Muscle Invasive Bladder Neoplasms; 126 are open to participants now.

This study's enrollment of 570 is above the median of 300 across 49 observational studies indexed under Non-Muscle Invasive Bladder Neoplasms.

Browse Non-Muscle Invasive Bladder Neoplasms studies →

Lead sponsor

University of Washington is the lead sponsor of 1,433 studies on the registry; 225 are open to participants now.

Of its 158 completed or terminated interventional studies of FDA-regulated products, 136 (86%) have results posted.

Compared within Non-Muscle Invasive Bladder Neoplasms, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Urinary Bladder Neoplasms. The counts are of registry records indexed under each term, refreshed daily. How we classify →

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Sampling method
Non-probability sample

Study population

Patients with a diagnosis of recurrent high-grade NMIBC who are considering second-line treatment will be approached for participation in this observational study in addition to their caregivers. Enrollment at each site will aim for a 2:1 ratio of participants selecting bladder-sparing therapy to radical cystectomy in order to ensure adequate enrollment of radical cystectomy patients. There will also be a qualitative sub-study that will include interviews of 50 patients and 25 caregivers recruited from the observational cohort study.

Eligibility criteria

Patient Eligibility, Inclusion Criteria:

  1. Adult 18 years of age or older; and
  2. Presenting with high-grade NMIBC established by anatomic pathology as tumor stage classification Tis, Ta, or T1, and with:

    1. Pathology documentation from any hospital/clinic/medical center, and
    2. More than 50% urothelial carcinoma component in the specimen
  3. History of high-grade NMIBC established by anatomic pathology as tumor stage classification Tis, Ta, or T1; and
  4. Attempted or received induction BCG (at least 3 out of 6 instillations) at any point in time; and
  5. In the previous 12 months, received at least one instillation of any intravesical agent (induction or maintenance) or one administration of systemic therapy for NMIBC treatment.

Patient Eligibility, Exclusion Criteria:

  1. Any plasmacytoid or small cell (neuroendocrine) component in the pathology (past or current presentation);
  2. Previous history of cystectomy or radiation therapy for bladder cancer;
  3. Previous history of muscle-invasive bladder cancer or bladder cancer;
  4. Any history of upper tract urothelial carcinoma;
  5. Incarcerated in a detention facility or in police custody (patients wearing a monitoring device can be enrolled) at baseline/screening;
  6. to radical cystectomy (e.g., (ASA) physical status of 4, patient not considered a radical cystectomy candidate due to comorbidity);
  7. Contraindication to medical therapy (i.e., intolerant of all medical therapies);
  8. Unable to provide written in English;
  9. Unable to be contacted for research surveys;
  10. Planning to participate in a Phase I or Phase II interventional clinical trial for NMIBC (unless in the control/comparator arm of a Phase II trial) or any blinded interventional trial for NMIBC.
Terms in these criteria, in plain language(4)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

ASA physical status

The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

05

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
570 participants (actual)
Patient registry
No

Groups and cohorts

  • Patients who have selected radical cystectomy

    Patients with a diagnosis of recurrent high-grade NMIBC who have selected radical cystectomy

  • Patients who have selected bladder-sparing therapy

    Patients with a diagnosis of recurrent high-grade NMIBC who have selected bladder-sparing therapy (BST)

06

What researchers measure

Primary outcomes

  1. Patient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)

    The primary outcome of patient-reported quality of life is measured by the EORTC QLQ-C30 Physical Function scale. The scale ranges in score from 0 to 100, with higher function scores indicating better health. Scale score is calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100. Each scale requires responses for at least 50% of the items in order to be calculated.

    Time frame: 12 months after enrollment

  2. Patient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)

    Patient-reported quality of life is measured by the EORTC QLQ-C30 Physical Function scale. The scale ranges in score from 0 to 100, with higher function scores indicating better health. Scale score is calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100. Each scale requires responses for at least 50% of the items in order to be calculated.

    Time frame: 24 months after enrollment

  3. Patient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)

    Patient-reported quality of life is measured by the EORTC QLQ-C30 Physical Function scale. The scale ranges in score from 0 to 100, with higher function scores indicating better health. Scale score is calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100. Each scale requires responses for at least 50% of the items in order to be calculated.

    Time frame: 60 months after enrollment

Secondary outcomes

  1. Patient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score

    The evaluation of the effect of treatment choice on patient-reported urinary health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate the two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 12 months after enrollment

  2. Patient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score

    The evaluation of the effect of treatment choice on patient-reported urinary health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate the two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 24 months after enrollment

  3. Patient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score

    The evaluation of the effect of treatment choice on patient-reported urinary health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate the two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 60 months after enrollment

  4. Patient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score

    The evaluation of the effect of treatment choice on patient-reported sexual health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 12 months after enrollment

  5. Patient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score

    The evaluation of the effect of treatment choice on patient-reported sexual health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 24 months after enrollment

  6. Patient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score

    The evaluation of the effect of treatment choice on patient-reported sexual health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 60 months after enrollment

  7. Patient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score

    The evaluation of the effect of treatment choice on patient-reported bowel health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 12 months after enrollment

  8. Patient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score

    The evaluation of the effect of treatment choice on patient-reported bowel health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 24 months after enrollment

  9. Patient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score

    The evaluation of the effect of treatment choice on patient-reported bowel health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

    Time frame: 60 months after enrollment

  10. Patient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)

    The evaluation of the effect of treatment choice on patient-reported financial distress, as measured by the Comprehensive Score for Financial Toxicity (COST). The COST questionnaire consists of 11 items, each scored on a 5-point Likert scale from zero to four. After reversing some items as indicated in the scoring manual (by reversing the sign on the original zero to four score and adding four), all item response scores are summed into a single financial toxicity score ranging from 0 to 44, with higher scores indicating greater financial wellbeing. Each subscale requires responses for at least 50% of the items in that subscale in order to be calculated. Item nonresponse is accounted for by substituting the mean of the completed items in the subscale.

    Time frame: 12 months after enrollment

  11. Patient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)

    The evaluation of the effect of treatment choice on patient-reported financial distress, as measured by the Comprehensive Score for Financial Toxicity (COST). The COST questionnaire consists of 11 items, each scored on a 5-point Likert scale from zero to four. After reversing some items as indicated in the scoring manual (by reversing the sign on the original zero to four score and adding four), all item response scores are summed into a single financial toxicity score ranging from 0 to 44, with higher scores indicating greater financial wellbeing. Each subscale requires responses for at least 50% of the items in that subscale in order to be calculated. Item nonresponse is accounted for by substituting the mean of the completed items in the subscale.

    Time frame: 24 months after enrollment

  12. Patient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)

    The evaluation of the effect of treatment choice on patient-reported financial distress, as measured by the Comprehensive Score for Financial Toxicity (COST). The COST questionnaire consists of 11 items, each scored on a 5-point Likert scale from zero to four. After reversing some items as indicated in the scoring manual (by reversing the sign on the original zero to four score and adding four), all item response scores are summed into a single financial toxicity score ranging from 0 to 44, with higher scores indicating greater financial wellbeing. Each subscale requires responses for at least 50% of the items in that subscale in order to be calculated. Item nonresponse is accounted for by substituting the mean of the completed items in the subscale.

    Time frame: 60 months after enrollment

  13. Patient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a

    The evaluation of patient-reported anxiety, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

    Time frame: 12 months after enrollment

  14. Patient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a

    The evaluation of patient-reported anxiety, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

    Time frame: 24 months after enrollment

  15. Patient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a

    The evaluation of patient-reported anxiety, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

    Time frame: 60 months after enrollment

  16. Patient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a

    The evaluation of patient-reported depression, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

    Time frame: 12 months after enrollment

  17. Patient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a

    The evaluation of patient-reported depression, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

    Time frame: 24 months after enrollment

  18. Patient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a

    The evaluation of patient-reported depression, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

    Time frame: 60 months after enrollment

  19. Patient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L

    The evaluation of patient-reported generic quality of life as measured by the EuroQoL EQ-5D-5L (EQ-5D). Scores range from 0 to 1, with higher scores indicating better health.

    Time frame: 12 months after enrollment

  20. Patient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L

    The evaluation of patient-reported generic quality of life as measured by the EuroQoL EQ-5D-5L (EQ-5D). Scores range from 0 to 1, with higher scores indicating better health.

    Time frame: 24 months after enrollment

  21. Patient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L

    The evaluation of patient-reported generic quality of life as measured by the EuroQoL EQ-5D-5L (EQ-5D). Scores range from 0 to 1, with higher scores indicating better health.

    Time frame: 60 months after enrollment

  22. Patient Recurrence-free Survival

    The evaluation of the effect of treatment choice on recurrence-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (recurrence or death). A recurrence was defined as any subsequent episode of high-grade bladder cancer in the bladder or elsewhere in the urinary tract (penile urethra, prostatic urethra, ureters, renal pelvis), either non-muscle or muscle invasive bladder cancer (for cystectomy arm this excludes any finding at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment

  23. Patient Recurrence-free Survival

    The evaluation of the effect of treatment choice on recurrence-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (recurrence or death). A recurrence was defined as any subsequent episode of high-grade bladder cancer in the bladder or elsewhere in the urinary tract (penile urethra, prostatic urethra, ureters, renal pelvis), either non-muscle or muscle invasive bladder cancer (for cystectomy arm this excludes any finding at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  24. Patient Recurrence-free Survival

    The evaluation of the effect of treatment choice on recurrence-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (recurrence or death). A recurrence was defined as any subsequent episode of high-grade bladder cancer in the bladder or elsewhere in the urinary tract (penile urethra, prostatic urethra, ureters, renal pelvis), either non-muscle or muscle invasive bladder cancer (for cystectomy arm this excludes any finding at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  25. Patient Metastasis-free Survival

    The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A metastasis was defined as metastasis to distant lymph/nodes organs (pathologic or radiologic diagnosis of M+ disease) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment

  26. Patient Metastasis-free Survival

    The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A metastasis was defined as metastasis to distant lymph/nodes organs (pathologic or radiologic diagnosis of M+ disease) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  27. Patient Metastasis-free Survival

    The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A metastasis was defined as metastasis to distant lymph/nodes organs (pathologic or radiologic diagnosis of M+ disease) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  28. Patient Progression-free Survival

    The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A progression was defined as any subsequent episode of muscle-invasive (T2-T4) disease in the bladder or elsewhere in the urinary tract AND/OR locoregional (true pelvic/common iliac) nodal disease (N+) AND/OR distant metastasis (M+) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment

  29. Patient Progression-free Survival

    The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A progression was defined as any subsequent episode of muscle-invasive (T2-T4) disease in the bladder or elsewhere in the urinary tract AND/OR locoregional (true pelvic/common iliac) nodal disease (N+) AND/OR distant metastasis (M+) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  30. Patient Progression-free Survival

    The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A progression was defined as any subsequent episode of muscle-invasive (T2-T4) disease in the bladder or elsewhere in the urinary tract AND/OR locoregional (true pelvic/common iliac) nodal disease (N+) AND/OR distant metastasis (M+) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

    Time frame: 60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  31. Patient Bladder Cancer-specific Survival

    The evaluation of the effect of treatment choice on bladder cancer-specific survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death from bladder cancer). Censoring occurred at the last electronic health record review or date of death from bladder cancer.

    Time frame: 12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment

  32. Patient Bladder Cancer-specific Survival

    The evaluation of the effect of treatment choice on bladder cancer-specific survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death from bladder cancer). Censoring occurred at the last electronic health record review or date of death from bladder cancer.

    Time frame: 24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  33. Patient Bladder Cancer-specific Survival

    The evaluation of the effect of treatment choice on bladder cancer-specific survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death from bladder cancer). Censoring occurred at the last electronic health record review or date of death from bladder cancer.

    Time frame: 60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  34. Patient Overall Survival

    The evaluation of the effect of treatment choice on overall survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death). Censoring occurred at the last electronic health record review or date of death.

    Time frame: 12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment

  35. Patient Overall Survival

    The evaluation of the effect of treatment choice on overall survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death). Censoring occurred at the last electronic health record review or date of death.

    Time frame: 24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

  36. Patient Overall Survival

    The evaluation of the effect of treatment choice on overall survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death). Censoring occurred at the last electronic health record review or date of death.

    Time frame: 60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

07

Results

Posted Nov 4, 2025

Participant flow

Participant flow — Overall Study
MilestonePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Started371199
12-months from enrollment303174
Completed303174
Not completed6825
Withdrew: Withdrawal by subject81
Withdrew: Death1911
Withdrew: Lost to follow-up4113

Outcome measures

PrimaryPatient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)

The primary outcome of patient-reported quality of life is measured by the EORTC QLQ-C30 Physical Function scale. The scale ranges in score from 0 to 100, with higher function scores indicating better health. Scale score is calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100. Each scale requires responses for at least 50% of the items in order to be calculated.

Time frame:
12 months after enrollment
Reported as:
Mean · score on a scale
Patient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)
score on a scalePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)85.0 ± 18.986.5 ± 17.5
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · TMLE · p = <0.05 (We tested the hypothesis that the average treatment effect (ATE) is different from zero. This was the only hypothesis test in our primary manuscript, and so no adjustment for multiple comparisons is necessary.) · Average treatment estimate (ate): 0.9 · 95% CI -0.6 to 2.4The causal mean difference in outcomes if all patients had been treated with radical cystectomy versus with bladder-sparing therapy. A positive value indicates greater physical functioning associated with radical cystectomy.
PrimaryPatient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)

Patient-reported quality of life is measured by the EORTC QLQ-C30 Physical Function scale. The scale ranges in score from 0 to 100, with higher function scores indicating better health. Scale score is calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100. Each scale requires responses for at least 50% of the items in order to be calculated.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

PrimaryPatient-reported Quality of Life as Measured by the Physical Function Scale of the European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30)

Patient-reported quality of life is measured by the EORTC QLQ-C30 Physical Function scale. The scale ranges in score from 0 to 100, with higher function scores indicating better health. Scale score is calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100. Each scale requires responses for at least 50% of the items in order to be calculated.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score

The evaluation of the effect of treatment choice on patient-reported urinary health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate the two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
12 months after enrollment
Reported as:
Mean · score on a scale
Patient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score
score on a scalePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score85.3 ± 16.783.8 ± 14.2
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: 1.2 · 95% CI -0.5 to 2.9The ATE is interpreted as the causal mean difference in outcomes if all patients had been treated with RC versus having been treated with BST. A positive value indicates greater urinary health associated with radical cystectomy.
SecondaryPatient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score

The evaluation of the effect of treatment choice on patient-reported urinary health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate the two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Urinary Health as Measured by the Bladder Cancer Index Urinary Summary Score

The evaluation of the effect of treatment choice on patient-reported urinary health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate the two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score

The evaluation of the effect of treatment choice on patient-reported sexual health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
12 months after enrollment
Reported as:
Mean · score on a scale
Patient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score
score on a scalePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score47.1 ± 25.732.6 ± 20.1
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: -11.9 · 95% CI -14.7 to -9.0The ATE is interpreted as the causal mean difference in outcomes if all patients had been treated with RC versus having been treated with BST. A positive value indicates greater sexual health associated with radical cystectomy.
SecondaryPatient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score

The evaluation of the effect of treatment choice on patient-reported sexual health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Sexual Health as Measured by the Bladder Cancer Index Sexual Summary Score

The evaluation of the effect of treatment choice on patient-reported sexual health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score

The evaluation of the effect of treatment choice on patient-reported bowel health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
12 months after enrollment
Reported as:
Mean · score on a scale
Patient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score
score on a scalePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score80.1 ± 9.577.2 ± 10.8
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: -1.4 · 95% CI -2.5 to -0.3The ATE is interpreted as the causal mean difference in outcomes if all patients had been treated with RC versus having been treated with BST. A negative value indicates worse bowel health associated with radical cystectomy.
SecondaryPatient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score

The evaluation of the effect of treatment choice on patient-reported bowel health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Bowel Health as Measured by the Bladder Cancer Index Bowel Summary Score

The evaluation of the effect of treatment choice on patient-reported bowel health, as measured by the Bladder Cancer Index (BCI). The BCI consists of 36 items, with 4- or 5-point Likert response scales, covering 3 primary domains: urinary, bowel, and sexual. For each domain a summary score is constructed from the items used to calculate two subscale scores (function and bother). Scores are calculated by transforming item responses into a 0 to 100 scale and calculating the mean of the standardized items. Higher scores indicate better health status. To calculate a score, a minimum of 80% completed items is required.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)

The evaluation of the effect of treatment choice on patient-reported financial distress, as measured by the Comprehensive Score for Financial Toxicity (COST). The COST questionnaire consists of 11 items, each scored on a 5-point Likert scale from zero to four. After reversing some items as indicated in the scoring manual (by reversing the sign on the original zero to four score and adding four), all item response scores are summed into a single financial toxicity score ranging from 0 to 44, with higher scores indicating greater financial wellbeing. Each subscale requires responses for at least 50% of the items in that subscale in order to be calculated. Item nonresponse is accounted for by substituting the mean of the completed items in the subscale.

Time frame:
12 months after enrollment
Reported as:
Mean · score on a scale
Patient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)
score on a scalePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)30.4 ± 9.931.0 ± 9.4
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: 1.4 · 95% CI 0.2 to 2.6The ATE is interpreted as the causal mean difference in outcomes if all patients had been treated with RC versus having been treated with BST. A positive value indicates greater financial health associated with radical cystectomy.
SecondaryPatient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)

The evaluation of the effect of treatment choice on patient-reported financial distress, as measured by the Comprehensive Score for Financial Toxicity (COST). The COST questionnaire consists of 11 items, each scored on a 5-point Likert scale from zero to four. After reversing some items as indicated in the scoring manual (by reversing the sign on the original zero to four score and adding four), all item response scores are summed into a single financial toxicity score ranging from 0 to 44, with higher scores indicating greater financial wellbeing. Each subscale requires responses for at least 50% of the items in that subscale in order to be calculated. Item nonresponse is accounted for by substituting the mean of the completed items in the subscale.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Self-reported Financial Distress as Measured by the Comprehensive Score for Financial Toxicity (COST)

The evaluation of the effect of treatment choice on patient-reported financial distress, as measured by the Comprehensive Score for Financial Toxicity (COST). The COST questionnaire consists of 11 items, each scored on a 5-point Likert scale from zero to four. After reversing some items as indicated in the scoring manual (by reversing the sign on the original zero to four score and adding four), all item response scores are summed into a single financial toxicity score ranging from 0 to 44, with higher scores indicating greater financial wellbeing. Each subscale requires responses for at least 50% of the items in that subscale in order to be calculated. Item nonresponse is accounted for by substituting the mean of the completed items in the subscale.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a

The evaluation of patient-reported anxiety, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

Time frame:
12 months after enrollment
Reported as:
Mean · T-score
Patient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a
T-scorePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a50.0 ± 8.948.8 ± 8.9
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: -2.4 · 95% CI -3.1 to -1.6
SecondaryPatient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a

The evaluation of patient-reported anxiety, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient-reported Anxiety as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a

The evaluation of patient-reported anxiety, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Anxiety 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a

The evaluation of patient-reported depression, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

Time frame:
12 months after enrollment
Reported as:
Mean · T-score
Patient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a
T-scorePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a48.0 ± 8.348.0 ± 8.2
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: -1.0 · 95% CI -1.8 to -0.3
SecondaryPatient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a

The evaluation of patient-reported depression, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient-reported Depression as Measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a

The evaluation of patient-reported depression, as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Short Form v1.0 - Depression 4a. Scores range from 0 to 100, with higher scores indicating greater symptoms. Scores are normalized to a mean of 50 and standard deviation of 10.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L

The evaluation of patient-reported generic quality of life as measured by the EuroQoL EQ-5D-5L (EQ-5D). Scores range from 0 to 1, with higher scores indicating better health.

Time frame:
12 months after enrollment
Reported as:
Mean · score on a scale
Patient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L
score on a scalePatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L0.84 ± 0.140.86 ± 0.13
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Tmle: 0.03 · 95% CI 0.01 to 0.04
SecondaryPatient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L

The evaluation of patient-reported generic quality of life as measured by the EuroQoL EQ-5D-5L (EQ-5D). Scores range from 0 to 1, with higher scores indicating better health.

Time frame:
24 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient-reported Generic Quality of Life as Measured by the EuroQoL EQ-5D-5L

The evaluation of patient-reported generic quality of life as measured by the EuroQoL EQ-5D-5L (EQ-5D). Scores range from 0 to 1, with higher scores indicating better health.

Time frame:
60 months after enrollment

Results for this outcome have not been posted.

SecondaryPatient Recurrence-free Survival

The evaluation of the effect of treatment choice on recurrence-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (recurrence or death). A recurrence was defined as any subsequent episode of high-grade bladder cancer in the bladder or elsewhere in the urinary tract (penile urethra, prostatic urethra, ureters, renal pelvis), either non-muscle or muscle invasive bladder cancer (for cystectomy arm this excludes any finding at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment
Reported as:
Count of participants · Participants
Patient Recurrence-free Survival
ParticipantsPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Recurrence-free Survival226176
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Risk ratio (rr): 1.45 · 95% CI 1.33 to 1.59Inverse probability weighted risk ratios calculated using quasi-Poisson regression. A weighted risk ratio \> 1 implies that participants who choose RC have a greater chance of surviving without recurrence than those who choose BST.
SecondaryPatient Recurrence-free Survival

The evaluation of the effect of treatment choice on recurrence-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (recurrence or death). A recurrence was defined as any subsequent episode of high-grade bladder cancer in the bladder or elsewhere in the urinary tract (penile urethra, prostatic urethra, ureters, renal pelvis), either non-muscle or muscle invasive bladder cancer (for cystectomy arm this excludes any finding at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Recurrence-free Survival

The evaluation of the effect of treatment choice on recurrence-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (recurrence or death). A recurrence was defined as any subsequent episode of high-grade bladder cancer in the bladder or elsewhere in the urinary tract (penile urethra, prostatic urethra, ureters, renal pelvis), either non-muscle or muscle invasive bladder cancer (for cystectomy arm this excludes any finding at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Metastasis-free Survival

The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A metastasis was defined as metastasis to distant lymph/nodes organs (pathologic or radiologic diagnosis of M+ disease) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment
Reported as:
Count of participants · Participants
Patient Metastasis-free Survival
ParticipantsPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Metastasis-free Survival330178
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Risk ratio (rr): 0.99 · 95% CI 0.94 to 1.03Inverse probability weighted risk ratios calculated using quasi-Poisson regression. A weighted risk ratio \< 1 implies that participants who choose RC have a lower chance of surviving without metastasis than those who choose BST.
SecondaryPatient Metastasis-free Survival

The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A metastasis was defined as metastasis to distant lymph/nodes organs (pathologic or radiologic diagnosis of M+ disease) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Metastasis-free Survival

The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A metastasis was defined as metastasis to distant lymph/nodes organs (pathologic or radiologic diagnosis of M+ disease) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Progression-free Survival

The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A progression was defined as any subsequent episode of muscle-invasive (T2-T4) disease in the bladder or elsewhere in the urinary tract AND/OR locoregional (true pelvic/common iliac) nodal disease (N+) AND/OR distant metastasis (M+) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment
Reported as:
Count of participants · Participants
Patient Progression-free Survival
ParticipantsPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Progression-free Survival319141
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Risk ratio (rr): 0.80 · 95% CI 0.73 to 0.88Inverse probability weighted risk ratios calculated using quasi-Poisson regression. A weighted risk ratio \< 1 implies that participants who choose RC have a lower chance of surviving without cancer progression than those who choose BST.
SecondaryPatient Progression-free Survival

The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A progression was defined as any subsequent episode of muscle-invasive (T2-T4) disease in the bladder or elsewhere in the urinary tract AND/OR locoregional (true pelvic/common iliac) nodal disease (N+) AND/OR distant metastasis (M+) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Progression-free Survival

The evaluation of the effect of treatment choice on metastasis-free survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (metastatis or death). A progression was defined as any subsequent episode of muscle-invasive (T2-T4) disease in the bladder or elsewhere in the urinary tract AND/OR locoregional (true pelvic/common iliac) nodal disease (N+) AND/OR distant metastasis (M+) (for cystectomy arm this includes findings at cystectomy). Censoring occurred at the last electronic health record review or death.

Time frame:
60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Bladder Cancer-specific Survival

The evaluation of the effect of treatment choice on bladder cancer-specific survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death from bladder cancer). Censoring occurred at the last electronic health record review or date of death from bladder cancer.

Time frame:
12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment
Reported as:
Count of participants · Participants
Patient Bladder Cancer-specific Survival
ParticipantsPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Bladder Cancer-specific Survival359192
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Risk ratio (rr): 0.98 · 95% CI 0.96 to 1.01Inverse probability weighted risk ratios calculated using quasi-Poisson regression. A weighted risk ratio \< 1 implies that participants who choose RC have a lower chance of surviving cancer than those who choose BST.
SecondaryPatient Bladder Cancer-specific Survival

The evaluation of the effect of treatment choice on bladder cancer-specific survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death from bladder cancer). Censoring occurred at the last electronic health record review or date of death from bladder cancer.

Time frame:
24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Bladder Cancer-specific Survival

The evaluation of the effect of treatment choice on bladder cancer-specific survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death from bladder cancer). Censoring occurred at the last electronic health record review or date of death from bladder cancer.

Time frame:
60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Overall Survival

The evaluation of the effect of treatment choice on overall survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death). Censoring occurred at the last electronic health record review or date of death.

Time frame:
12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment
Reported as:
Count of participants · Participants
Patient Overall Survival
ParticipantsPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
Patient Overall Survival351190
Statistical analysis
  • Patients Who Have Selected Bladder-sparing Therapy vs Patients Who Have Selected Radical Cystectomy · Risk ratio (rr): 0.89 · 95% CI 0.38 to 2.08A weighted risk ratio \< 1 implies that participants who choose radical cystectomy have a lower chance of surviving than those who choose bladder-sparing therapy.
SecondaryPatient Overall Survival

The evaluation of the effect of treatment choice on overall survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death). Censoring occurred at the last electronic health record review or date of death.

Time frame:
24 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

SecondaryPatient Overall Survival

The evaluation of the effect of treatment choice on overall survival. Survival times were calculated from the date of diagnosis of recurrent high-grade non-muscle invasive bladder cancer to the event (death). Censoring occurred at the last electronic health record review or date of death.

Time frame:
60 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer

Results for this outcome have not been posted.

Adverse events

Collected over Time frame for all-cause mortality is 12 months post enrollment to match participant flow. Time frame for all other adverse events is 12 months after diagnosis of recurrent high-grade non-muscle invasive bladder cancer, up to 12 months post enrollment.. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Patients Who Have Selected Bladder-sparing Therapy19/371 (5.1%)25/371 (6.7%)77/371 (20.8%)
Patients Who Have Selected Radical Cystectomy11/199 (5.5%)29/199 (14.6%)73/199 (36.7%)
Most frequent serious events
Showing 10 of 11
Most frequent serious events
EventPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
SepsisInfections and infestations3/3713/199
Abdominal infectionInfections and infestations1/3712/199
Small intestinal obstructionGastrointestinal disorders0/3712/199
Wound dehiscenceSurgical and medical procedures0/3712/199
PneumothoraxRespiratory, thoracic and mediastinal disorders2/3710/199
Lung infectionInfections and infestations1/3711/199
DyspneaRespiratory, thoracic and mediastinal disorders0/3711/199
Urinary tract obstructionRenal and urinary disorders0/3711/199
Postoperative hemorrhageSurgical and medical procedures1/3710/199
Chest pain - cardiacCardiac disorders1/3710/199
Most frequent other events
Most frequent other events
EventPatients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical Cystectomy
AnemiaBlood and lymphatic system disorders12/37140/199
Urinary tract infection (UTI)Renal and urinary disorders41/37132/199
NauseaGastrointestinal disorders13/37120/199
HematuriaRenal and urinary disorders32/3716/199

Baseline characteristics

Age, Continuous
Age, Continuous(years)Patients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical CystectomyTotal
Mean72.4 ± 8.369.6 ± 9.171.4 ± 8.7
Age, Customized
Age, Customized(Participants)Patients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical CystectomyTotal
greater than or equal to 75 years15062212
Less than 75 years221137358
Sex: Female, Male
Sex: Female, Male(Participants)Patients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical CystectomyTotal
Female7839117
Male293160453
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Patients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical CystectomyTotal
Hispanic or Latino391756
Not Hispanic or Latino332182514
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Patients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical CystectomyTotal
American Indian or Alaska Native101
Asian6410
Native Hawaiian or Other Pacific Islander000
Black or African American18826
White341184525
More than one race112
Unknown or Not Reported426
Partner status
Partner status(Participants)Patients Who Have Selected Bladder-sparing TherapyPatients Who Have Selected Radical CystectomyTotal
Partnered288170458
Unpartnered8329112
08

Study locations

36 sites
09

References and documents

Publications

  • Gore JL, Wolff EM, Nash MG, Comstock BA, Gilbert SM, Chang SS, Chisolm S, MacLean DB, Wright JL, Kates MR, Pohar KS, Guzzo TJ, Bivalacqua TJ, Nepple KG, Montgomery JS, Scarpato KR, Woldu SL, Master VA, Chen DYT, Mossanen M, Daneshmand S, O'Neil BB, Tyson MD, Westerman ME, Kamat AM, Mansour AM, Chamie K, Riggs SB, Kukreja JB, Modi PK, Garg T, Peyton CC, Nix JW, Dickstein R, Gadzinski AJ, Sankin A, Shore ND, Lane BR, Bassett JC, Patel S, Morris DS, Macleod LC, Lee EK, Ritch CR, Follmer KM, Lee JR, Kim SM, Kessler LG, Smith AB; CISTO Collaborative group. Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non-Muscle-Invasive Bladder Cancer. J Clin Oncol. 2026 Feb;44(4):274-285. doi: 10.1200/JCO-25-01324. Epub 2025 Dec 15. PubMed 41397208 ↗
  • Gore JL, Wolff EM, Comstock BA, Follmer KM, Nash MG, Basu A, Chisolm S, MacLean DB, Lee JR, Lotan Y, Porten SP, Steinberg GD, Chang SS, Gilbert SM, Kessler LG, Smith AB; CISTO Collaborative. Protocol of the Comparison of Intravesical Therapy and Surgery as Treatment Options (CISTO) study: a pragmatic, prospective multicenter observational cohort study of recurrent high-grade non-muscle invasive bladder cancer. BMC Cancer. 2023 Nov 18;23(1):1127. doi: 10.1186/s12885-023-11605-8. PubMed 37980511 ↗

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: Yes — De-identified study data will be shared according to the PCORI policy for data management and data sharing.

Supporting information: Study protocol, Statistical analysis plan

Time frame: The PCORI-designated repository will make the data available for third-party requests when PCORI makes the Final Research Report available on the PCORI website pursuant to PCORI's Process for Peer Review of Primary Research and Public Release of Research Findings. Data will be available in perpetuity.

Access criteria: Individual investigators or teams of investigators seeking access to data from PCORI-funded studies must complete and submit a data request form to the PCORI-designated repository.

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Jul 2019 to primary completion in Jan 2025, 66 months.

Results were first posted in Nov 2025, 9 months after primary completion.

Of 29 observational studies under Non-Muscle Invasive Bladder Neoplasms, half reached primary completion within 42 months of starting (the median), counting those still running; a quarter within 30. This study's 66 months is above that.

How these figures are worked out, and which studies are left out of them.

Registered
Apr 19, 2019
First posted
May 1, 2019
StartActual
Jul 9, 2019
Primary completionActual
Jan 31, 2025
CompletionEst.
Jun 30, 2029
Results first posted
Nov 4, 2025
Last update
May 12, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 12, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT03933826
Collaborators
Patient-Centered Outcomes Research Institute
Responsible party
John Gore (Associate Professor, School of Medicine: Urology, University of Washington) — Principal investigator
First posted
May 1, 2019
Start date
Jul 9, 2019
Primary completion
Jan 31, 2025
Completion
Jun 30, 2029 (estimated)
Results posted
Nov 4, 2025
Last update
May 12, 2026

Study contacts

John L Gore, MD
principal investigator · University of Washington

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Apr 2026. You cannot join it, but the record below documents what was studied.

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