Precise vesical wall staging of bladder cancer in the era of precision medicine: has it been fulfilled?

Urinary bladder cancer is a global disease that poses medical and socioeconomic challenges to patients and healthcare systems. Predicting detrusor invasiveness and pathological grade of bladder cancer by the radiologist is imperative for informed decision-making and effective patient-tailored therapy. Cystoscopy and TURBT are the current gold standard for preoperative histologic diagnosis and local pathological staging but are compromised by their intrusiveness, under-sampling, and staging inaccuracies. Over the last few decades, incredible imaging technology advancements have enabled radiologists to progress in these grading and staging tasks. MRI has become widely accepted as a noninvasive alternative. It supplements morphologic data with functional insights into the tumor microenvironment, enhancing tumor characterization and predicting the detrusor's histologic grade and invasiveness status. Radiomics is a promising field that helps radiologists achieve higher accuracies in bladder cancer staging, re-staging, and direct treating teams to potential management readjustments. Such knowledge leaps hold promise for personalized management of bladder cancer in a precision medicine era.