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Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent

John L Gore¹, Erika M Wolff¹, Michael G Nash²

¹Department of Urology, University of Washington, Seattle, WA.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology

|December 15, 2025

Summary

Radical cystectomy (RC) and bladder-sparing therapy (BST) showed similar physical function in high-grade non-muscle-invasive bladder cancer (NMIBC) patients at 12 months. RC offered better emotional well-being but higher adverse event risks.

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Area of Science:

Urology
Oncology
Patient-Reported Outcomes

Background:

Recurrent high-grade non-muscle-invasive bladder cancer (NMIBC) presents treatment challenges.
Radical cystectomy (RC) and bladder-sparing therapy (BST) are treatment options.
Patient preferences and outcomes are crucial in treatment selection.

Purpose of the Study:

To compare patient-reported and clinical outcomes between RC and BST.
To evaluate quality of life, emotional well-being, and cancer-specific survival.
To inform treatment decisions for recurrent high-grade NMIBC.

Main Methods:

Prospective observational cohort study of 570 eligible adults.
Patients selected their preferred treatment (RC or BST).
Outcomes assessed using EORTC-QLQ-C30, depression/anxiety scales, and cancer-specific survival; analyzed with TMLE and weighted regression.

Main Results:

No significant difference in physical function at 12 months between RC and BST.
RC associated with improved emotional function, QOL, and reduced depression/anxiety.
BST showed better bowel/sexual health; RC had higher adverse event rates and 90-day mortality (2.5%).

Conclusions:

Most patient-prioritized outcomes were similar or better with RC compared to BST.
RC remains a viable option for managing recurrent high-grade NMIBC.
Shared decision-making is essential, considering both oncologic and quality-of-life outcomes.