Patient Preferences, Treatment Received, and Quality of Life in the CISTO Study Comparing Radical Cystectomy or Bladder-Sparing Therapy For Recurrent High-Grade NMIBC

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: The CISTO Study demonstrated that most outcomes, including physical functioning, depression, anxiety, and overall quality of life (QOL), were similar or better 12 months after radical cystectomy (RC) compared with bladder-sparing therapy (BST) for recurrent high-grade non-muscle invasive bladder cancer (NMIBC). To support decision-making in this setting, we sought to understand how patient preferences impact treatment selection and outcomes .METHODS: The CISTO Study is a pragmatic trial among patients with recurrent high-grade NMIBC eligible for both RC and BST who selected their treatment. Baseline surveys assessed certainty of cure and willingness to accept treatment-related burdens in exchange for longevity. Health state utilities (HSU) were calculated for three health states (anticipated retained/removed bladder, current health) at baseline and 12 months via electronic time tradeoff (TTO)instruments. Treatment preference was defined as the anticipated health state with higher baseline utility. Correlations with treatment selected and the association between preference-treatment discordance and 12-month outcomes were evaluated. Semi structured interviews with patients, selected via purposive sampling, were analyzed using deductive coding to capture factors influencing treatment decisions and perspectives on QOL impacts. RESULTS: Among 570 participants, 371 selected BST and 199 selected RC. Patients who selected RC more often reported high certainty of cure (28% vs 14%) and willingness to undergo major surgery. Of 296 completing baseline TTOs, 45% preferred a retained bladder(0.83 vs. 0.48), 18% preferred a removed bladder (0.48 vs. 0.84), and 37% had no preference (0.79 for both). Treatment preferences strongly correlated with treatment chosen (RC: 68% who preferred removed, 48% with no preference, 15% who preferred retained). Preference-treatment discordance was not associated with 12-month outcomes. Interviews revealed that participants who underwent RC (n=22) had unexpectedly strong physical recovery, improved emotional well-being, and relief from anxiety. Participants who chose BST (n=28) tolerated ongoing treatments and surveillance to retain their bladder and avoid anticipated QOL impacts of RC. CONCLUSIONS: Patients often chose BST to avoid perceived QOL impacts of RC, yet those who underwent RC reported excellent recovery and QOL. Outcomes were similar regardless of whether treatment received aligned with patient preference, demonstrating both options can achieve favorable results. The CISTO Study provides evidence to recalibrate expectations about life after RC and support better informed decision-making.

Volume

215

Issue

5S

First Page

e1448

Last Page

e1448

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191716.05440.37.05

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