Christensen E, et al. - Researchers assessed the prognostic and predictive effect of ultra-deep sequencing of cell-free DNA in patients prior to and following cystectomy and during chemotherapy. In this study with 68 patients who had localized advanced bladder cancer, they found a high prognostic impact in circulating tumor DNA (ctDNA) presence at diagnosis before chemotherapy. With 100% sensitivity and 98% specificity, correct identification of all patients with metastatic relapse during disease monitoring was enabled by ctDNA analysis after cystectomy. Compared to other available methods, ctDNA analysis was better correlated to treatment effectiveness. In bladder cancer, findings suggest the feasibility of ctDNA evaluation for early risk stratification, therapy monitoring, and early relapse detection.