Shawn was diagnosed with stage III bladder cancer in 2021. After meeting with John Sfakianos, MD, he underwent surgery to remove his bladder. His treatment also included chemotherapy, which was interrupted after he experienced a stroke, followed by a year of immunotherapy.
Muscle-invasive bladder cancer can be aggressive, and recurrence remains a concern after surgery for some patients. As part of Shawn’s surveillance plan, Dr. Sfakianos recommended circulating tumor DNA, or ctDNA, testing. ctDNA refers to DNA from cancer cells that can sometimes be detected in the bloodstream.
For Shawn, blood samples were collected at home and results were reviewed with his care team. His ctDNA testing was initially performed every three months, then spaced to every six months, and is now performed annually as he remains cancer-free. He describes the testing as one way to stay informed and feel reassured while continuing routine cancer follow-up.
Every patient’s bladder cancer, treatment path, and follow-up needs are different. Shawn’s story illustrates how ctDNA may be used with cancer stage, pathology, imaging, treatment history, symptoms, and other clinical information to support individualized surveillance decisions.
What you’ll hear
- Shawn’s experience receiving a stage III bladder cancer diagnosis
- Why his care team recommended prompt surgery for muscle-invasive bladder cancer
- His experience with chemotherapy, a stroke, and subsequent immunotherapy
- Why recurrence can remain a concern after bladder cancer surgery
- What ctDNA is and how it may be detected through a blood test
- How Shawn incorporated blood-based ctDNA testing into his follow-up plan
- Why a detectable or rising ctDNA result may lead to a conversation about additional evaluation
- Why ctDNA results should be interpreted with pathology, cancer stage, imaging, treatment history, and other clinical information
- Shawn’s perspective on the reassurance that ongoing monitoring can provide during remission
What is ctDNA?
Circulating tumor DNA, or ctDNA, is DNA from cancer cells that can sometimes be found in the bloodstream. As cells break down, they can release DNA into the blood. A ctDNA test looks for DNA associated with a person’s tumor.
For some people with bladder cancer, a detectable ctDNA result may raise concern about a possible recurrence or a higher risk of recurrence. A rising ctDNA level may prompt the oncology team to consider closer follow-up, additional imaging, or other evaluation. However, ctDNA results must be interpreted carefully and in context. A ctDNA test alone does not diagnose a recurrence or determine treatment.
Dr. Sfakianos explains that ctDNA is another tool in the care team’s “toolbox.” It is used alongside cancer stage and grade, pathology findings, prior treatment, imaging, clinical examination, symptoms, and other information—not independently.
Why surveillance matters
After surgery for muscle-invasive bladder cancer, follow-up care is designed to monitor for possible recurrence and address a patient’s individual risk. The intensity and timing of surveillance may differ based on the cancer’s pathology, stage, grade, treatment history, and other personal factors.
For Shawn, ctDNA monitoring began every three months. As he continued to have favorable results and remained cancer-free, his testing schedule was gradually extended to every six months and then once a year. This schedule was specific to his care plan and should not be considered a standard schedule for all people with bladder cancer.
A detectable or rising ctDNA result can be a signal for the care team to look more closely, even if imaging has not yet identified a recurrence. Conversely, an undetectable result can be reassuring, but it does not eliminate the need for recommended appointments, imaging, laboratory tests, and other standard follow-up care.
Questions to ask your care team
If you have muscle-invasive bladder cancer or are planning follow-up after treatment, you may want to ask:
- What is my individual risk that bladder cancer could return after surgery or other treatment?
- What follow-up tests, scans, and appointments are recommended for me?
- Is ctDNA testing appropriate for my type and stage of bladder cancer?
- What question would ctDNA testing help answer in my situation?
- How would a detectable or rising ctDNA result affect my surveillance plan?
- What would an undetectable result mean, and what follow-up would I still need?
- Would ctDNA testing change the timing of imaging or other evaluations?
- How often might testing be performed, and could that schedule change over time?
- Is ctDNA testing covered by my insurance, and are financial-assistance options available?
- Are there clinical trials evaluating ctDNA-guided monitoring or treatment in bladder cancer that may be appropriate for me?
Shawn’s experience underscores the value of an individualized follow-up plan after bladder cancer treatment. Talk with your oncology or urology team about your recurrence risk, recommended surveillance schedule, and whether ctDNA testing may provide useful additional information in your situation.
Patient information disclaimer
Shawn’s experience is personal and may not represent the experience of every person with bladder cancer. ctDNA testing is not appropriate for every patient and does not replace pathology, imaging, laboratory testing, cystoscopy or other recommended surveillance procedures, clinical follow-up, or individualized guidance from an oncology and urology care team. Patients should discuss their diagnosis, treatment history, recurrence risk, and follow-up options with their doctor.
This educational resource was made possible by Natera, OmniOncology, and The Personalized Medicine Foundation.
