BackTable Urology Ep. 256 The Role of ctDNA in Bladder Cancer Diagnosis & Treatment with Dr. Alberto Pieretti
Aug 22, 2025
Dr. Alberto Pieretti, a urologic oncologist at Cleveland Clinic Weston Hospital, speaks with Dr. Jose Silva about the groundbreaking potential of circulating tumor DNA (ctDNA) in bladder cancer. They discuss how ctDNA can refine treatment decisions, identify patients at risk of recurrence, and even detect actionable mutations for precision therapies. The conversation highlights the implications for early detection and personalization of care, as well as ongoing trials that aim to integrate ctDNA into clinical practice, shaping the future of urologic oncology.
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ctDNA Is Changing Bladder Cancer Care
- ctDNA is rapidly emerging and may change staging, monitoring, and treatment decisions in bladder cancer.
- Publications and adoption in academic centers have surged in the last 2–3 years.
Do Complete TURBTs And Counsel High-Risk Patients
- Perform a thorough TURBT to avoid leaving tumor behind and to enable appropriate staging and treatment selection.
- High-risk non‑muscle invasive patients should receive counseling and recommended adjuvant intravesical therapy.
How ctDNA Tests Work
- ctDNA detects tumor-derived DNA in blood and can indicate microscopic residual or advanced disease.
- Most tests match tumor mutations to plasma using targeted NGS panels for detection.