Monitoring high-risk bladder cancer

Abstract

Monitoring high-risk nonmuscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) is challenging since currently used clinical and pathological risk parameters are not accurate enough to address the individual risk of progression. In NMIBC, the use of urinary interleukin-2 and fluorescence in-situ hybridization predicts response to bacille-calmette-guerin treatment. In both NMIBC and MIBC, the detection of circulating tumor cells at initial diagnosis allows improved monitoring since its presence is associated with higher tumor stages, concomitant carcinoma in situ and shorter time to recurrence. Molecular urine markers, such as fluorescence-in-situ hybridization, help to identify high-risk cases early on. In MIBC, serum C-reactive protein and thrombocytosis have been recently incorporated into basic prognostic models and demonstrated an increase in the predictive accuracy of standard pathological risk factors. New serological and urine-based markers have been identified for monitoring high-risk bladder cancer, and demand incorporation into established clinicopathological risk models to tailor surveillance regimens and provide improved prognostication for the need of adjuvant treatment.