Review of the Clinical Approaches to the Use of Urine-based Tumor Markers in Bladder Cancer.

Timothy Clinton,Yair Lotan

doi:10.5041/rmmj.10314

Abstract

Bladder cancer is a common disease with a stable incidence for the past few decades despite advancements in molecular and genetic determinants of cancer development and progression. Cystoscopy remains the standard for detection and surveillance of bladder cancer, but it is an invasive and potentially costly procedure. With the knowledge of molecular alterations associated with bladder cancer numerous urine-based tumor markers have become commercially available. These urine markers have been evaluated in all clinical scenarios for the detection of bladder cancer including screening, hematuria, atypical cytology evaluation, and surveillance, but given the relative lack of impactful trials they are not routinely utilized. The efforts to develop markers with increased sensitivity to replace cystoscopy for the detection of bladder cancer have thus far been unsuccessful as well. This review addresses role of urine markers for screening, detection, and surveillance of bladder cancer.

Highlights

Bladder cancer remains the fifth most frequent noncutaneous malignancy in the United States with over 79,000 estimated new cases for 2017.1 The incidence of bladder cancer has remained stable from 1988 to 2006, and the distribution of bladder cancer by stage has remained stable from 2004 to 2010 based on evaluation of the Surveillance, Epidemiology and End Results (SEER) database.[2,3] Despite advancements in biologic processes, genetics, diagnosis, treatment, and surveillance of bladder cancer the role of markers in identifying disease is still unclear
Despite attempts at initial control of non-muscle invasive bladder cancer (NMIBC), 50%–70% recur, with 10%–20% progressing to muscleinvasive bladder cancer (MIBC).[5]
The initial evaluation of the nomogram of 1272 patients had a predictive accuracy of 0.82. This model was validated in a prospective multicenter study for those patients referred for hematuria evaluation.[36]

Summary

Introduction

Bladder cancer remains the fifth most frequent noncutaneous malignancy in the United States with over 79,000 estimated new cases for 2017.1 The incidence of bladder cancer has remained stable from 1988 to 2006, and the distribution of bladder cancer by stage has remained stable from 2004 to 2010 based on evaluation of the Surveillance, Epidemiology and End Results (SEER) database.[2,3] Despite advancements in biologic processes, genetics, diagnosis, treatment, and surveillance of bladder cancer the role of markers in identifying disease is still unclear.

Results

Conclusion