ObjectiveTo determine patient experience and perception following a diagnosis of non-muscle-invasive bladder cancer (NMIBC). Patient and methodsPatients were part of a prospective multicentre observational study recruiting patients with NMIBC for a urine biomarker study (DETECT II; ClinicalTrials.gov: NCT02781428). A mixed-methods approach comprising: (i) the Brief Illness Perception Questionnaire (Brief-IPQ) and (ii) semi-structured interviews to explore patients' experience of having haematuria, and initial and subsequent experience with a NMIBC diagnosis. Both assessments were completed at 6 months after NMIBC diagnosis. ResultsA total of 213 patients completed the Brief-IPQ. Patients felt that they had minimal symptoms (median [interquartile range, IQR] score 2 [0-5]) and were not particularly affected emotionally (median [IQR] score 3 [1-6]) with a minimal effect to their daily life (median [IQR] score 2 [0-5]). However, they remained concerned about their cancer diagnosis (median [IQR] score 5 [3-8]) and felt that they had no personal control over the cancer (median [IQR] score 2 [2-5]) and believed that their illness would affect them for some time (median [IQR] score 6 [3-10]). A significant association with a lower personal control of the disease (P < 0.05) and a poorer understanding of the management of NMIBC (P < 0.05) was seen in patients aged >70 years. Many patients were uncertain about the cause of bladder cancer. Qualitative analysis found that at initial presentation of haematuria, most patients were not aware of the risk of bladder cancer. Patients were most anxious and psychologically affected between the interval of cystoscopy diagnosis and transurethral resection of bladder tumour (TURBT). Following TURBT, most patients were positive about their cancer prognosis.

Objectives To determine the minimal accepted sensitivity (MAS) of a urine biomarker that patients are willing to accept to replace cystoscopy and to assess qualitatively their views and reasons. Patients and Methods Patients were part of a prospective multicentre observational study recruiting people with bladder cancer for a urine biomarker study (DETECT II; ClinicalTrials.gov: NCT02781428). A mixed‐methods approach comprising (1) a questionnaire to assess patients’ experience with cystoscopy and patients’ preference for cystoscopy vs urinary biomarker, and (2) semi‐structured interviews to understand patient views, choice and reasons for their preference. Results A urine biomarker with an MAS of 90% would be accepted by 75.8% of patients. This was despite a high self‐reported prevalence of haematuria (51.0%), dysuria/lower urinary tract symptoms (69.1%) and urinary tract infection requiring antibiotics (25.8%). There was no association between MAS with patient demographics, adverse events experienced, cancer characteristics or distance of patients’ home to hospital. The qualitative analysis suggested that patients acknowledge that cystoscopy is invasive, embarrassing and associated with adverse events but are willing to tolerate the procedure because of its high sensitivity. Patients have confidence in cystoscopy and appreciate the visual diagnosis of cancer. Both low‐ and high‐risk patients would consider a biomarker with a reported sensitivity similar to that of cystoscopy. Conclusion Patients value the high sensitivity of cystoscopy despite the reported discomfort and adverse events experienced after it. The sensitivity of a urinary biomarker must be close to cystoscopy to gain patients’ acceptance.

and hydronephrosis on imaging was identified in 19 (14.8%) and 45 (35.2%) patients, respectively. On univariate analysis, PS on imaging was not significantly associated with imaging type (p [0.383), greater BMI (p [0.176), or higher pathologic T stage (p[0.243). Additionally, grading of stranding did not improve the association with pathologic T stage (p[0.208). However, hydronephrosis on imaging was seen more frequently in higher pathologic T stage (p[0.034; 22 (45.8%) in pT3 and 7 (58.3%) in pT4). Multivariable analysis noted that PS on imaging was not predictive of !pT3 BC following RC (OR 1.5, 95% CI [0.5, 4.1], p[0.457). Stratification by grade of stranding did not improve the predictive capacity of PS (p[0.667 for severe vs. no stranding). Hydronephrosis, on the other hand, remained a predictive imaging indicator of !pT3 BC following RC (OR 3.3, 95% CI [1.5, 7.2], p[0.003).CONCLUSIONS: Perivesical stranding on preoperative staging imaging failed to be a reliable predictor of !pT3 stage in patients with BC. However, hydronephrosis continued to act as a strong imaging indicator of higher pathological stage. This data should give pause in using perivesical stranding identified on preoperative imaging to guide clinical decision making in BC patients until further investigations can be explored in larger cohorts.