Diagnosis Of Urinary Tract Cancer Research Articles

PD29-01 THE HEMATURIA CANCER RISK SCORE: A VALIDATION STUDY DEMONSTRATING REDUCTION IN THE NUMBER NEEDED TO INVESTIGATE WHILE PRESERVING FIDELITY OF CANCER DETECTION

You have accessJournal of UrologyCME1 Apr 2023PD29-01 THE HEMATURIA CANCER RISK SCORE: A VALIDATION STUDY DEMONSTRATING REDUCTION IN THE NUMBER NEEDED TO INVESTIGATE WHILE PRESERVING FIDELITY OF CANCER DETECTION Wei Shen Tan, Amar Ahmad, Arjun Nathan, Ayodeji Ogunbo, Olayinka Gbolahan, Neha Kallam, Wei Phin Tan, Daniel Cohen, Dimitrios Volanis, Ashish Kamat, and John Kelly Wei Shen TanWei Shen Tan More articles by this author , Amar AhmadAmar Ahmad More articles by this author , Arjun NathanArjun Nathan More articles by this author , Ayodeji OgunboAyodeji Ogunbo More articles by this author , Olayinka GbolahanOlayinka Gbolahan More articles by this author , Neha KallamNeha Kallam More articles by this author , Wei Phin TanWei Phin Tan More articles by this author , Daniel CohenDaniel Cohen More articles by this author , Dimitrios VolanisDimitrios Volanis More articles by this author , Ashish KamatAshish Kamat More articles by this author , and John KellyJohn Kelly More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003315.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hematuria is a cardinal symptom of urinary tract cancer and is used to advocate selective screening in this patient cohort. Guidelines vary on who should be investigated following a presentation of hematuria. We report the external validation of the Hematuria Cancer Risk Score (HCRS), a risk assessment tool, to better selective patients who should receive hematuria investigations. METHODS: The HCRS was developed previously using a prospective cohort of 3,539 patients investigated for hematuria across 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180). The external validation cohort consisted of 500 consecutive patients referred to secondary care under an accelerated access pathway for hematuria investigations. Patients included received cystoscopy and upper tract imaging. A diagnosis of cancer was based on histological confirmation. A predetermined cut-off was determined for the validation cohort. RESULTS: Of 500 patients in the validation cohort, 471 patients were included for analysis. Overall, 36 patients had a diagnosis of urinary tract cancer (33 [7.0%] bladder cancers, 3 [0.6%] upper tract cancers). Median HCRS was higher in patients diagnosed with bladder cancer compared to non-cancer patients (6.118 (IQR: 5.741-6.601) versus 5.265 (IQR: 4.423-6.142) p<0.001). Validation of the HCRS achieved a good discrimination with an AUC of 0.727 (95% CI 0.650–0.804) in the validation cohort. Utilizing a cut-off score of 4.015 allowed identification of 35 tumours (97%) while simultaneously reducing the number of patients undergoing investigation by 72 patients (15%). This includes all three patients with upper tract tumours (1 RCC, 2 UTUC). Only a G1 Ta bladder cancer was missed. CONCLUSIONS: We report the HCRS offers good discriminatory ability in identifying patients who would benefit from investigation for hematuria. As many as 15% of patients referred for hematuria investigations could be spared from invasive procedures safely, leading to healthcare cost savings. The simplicity of the model allows for easy clinical adoption and can aid both patient and physician decision making. Source of Funding: DETECT I trial was funded my the Medical Research Council © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e824 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Shen Tan More articles by this author Amar Ahmad More articles by this author Arjun Nathan More articles by this author Ayodeji Ogunbo More articles by this author Olayinka Gbolahan More articles by this author Neha Kallam More articles by this author Wei Phin Tan More articles by this author Daniel Cohen More articles by this author Dimitrios Volanis More articles by this author Ashish Kamat More articles by this author John Kelly More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria

Microhematuria (MH) is a common finding that often leads to further evaluation for urinary tract cancers. There is ongoing debate about the extent to which patients with MH should be evaluated for cancer. To assess the diagnostic yield for detection of urinary tract cancers, specifically bladder cancer, upper tract urothelial carcinoma (UTUC), and kidney cell carcinoma, among patients evaluated for MH using cystoscopy and computed tomographic (CT) urography. MEDLINE, Scopus, and Embase were systematically searched for eligible studies published between January 1, 2009, and December 31, 2019. Original prospective and retrospective studies reporting the prevalence of cancer among patients evaluated for MH were eligible. Two authors independently screened the titles and abstracts to select studies that met the eligibility criteria and reached consensus about which studies to include. Among 5802 records identified, 5802 articles were screened using titles and abstracts. After exclusions, 55 full-text articles were assessed for eligibility, with 39 studies selected for systematic review. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Studies were quantitatively synthesized using a random-intercept logistic regression model. The primary outcome was diagnostic yield, defined as the proportion of patients with a diagnosis of urinary tract cancer (bladder cancer, UTUC, or kidney cell carcinoma) after presentation with MH. Studies were stratified by the percentage of cystoscopy and CT urography use and by high-risk cohorts. The diagnostic yields of CT urography and cystoscopy were calculated for each cancer type. A total of 30 studies comprising 24 366 patients evaluated for MH were included in the meta-analysis. The pooled diagnostic yield among all patients was 2.00% (95% CI, 1.30%-3.09%) for bladder cancer, 0.02% (95% CI, 0.0%-0.15%) for UTUC, and 0.18% (95% CI, 0.09%-0.36%) for kidney cell carcinoma. Stratification of studies that used cystoscopy and/or CT urography for 95% or more of the cohort produced diagnostic yields of 2.74% (95% CI, 1.81%-4.12%) for bladder cancer, 0.09% (95% CI, 0.01%-0.75%) for UTUC, and 0.10% (95% CI, 0.04%-0.23%) for kidney cell carcinoma. In high-risk cohorts, the diagnostic yields increased to 4.61% (95% CI, 2.34%-8.90%) for bladder cancer and 0.45% (95% CI, 0.22%-0.95%) for UTUC. This study's findings suggest that, given the low diagnostic yield of CT urography and the associated risks and costs, limiting its use to high-risk patients older than 50 years is warranted. Risk stratification, as recommended by the recent American Urology Association guidelines on MH, may be a better approach to tailor further evaluation.

Who Should Be Investigated for Haematuria? Results of a Contemporary Prospective Observational Study of 3556 Patients

There remains a lack of consensus among guideline relating to which patients require investigation for haematuria. We determined the incidence of urinary tract cancer in a prospective observational study of 3556 patients referred for investigation of haematuria across 40 hospitals between March 2016 and June 2017 (DETECT 1; ClinicalTrials.gov: NCT02676180) and the appropriateness of age at presentation in cases with visible (VH) and nonvisible (NVH) haematuria. The overall incidence of urinary tract cancer was 10.0% (bladder cancer 8.0%, renal parenchymal cancer 1.0%, upper tract transitional cell carcinoma 0.7%, and prostate cancer 0.3%). Patients with VH were more likely to have a diagnosis of urinary tract cancer compared with NVH patients (13.8% vs 3.1%). Older patients, male gender, and smoking history were independently associated with urinary tract cancer diagnosis. Of bladder cancers diagnosed following NVH, 59.4% were high-risk cancers, with 31.3% being muscle invasive. The incidence of cancer in VH patients <45 yr of age was 3.5% (n=7) and 1.0% (n=4) in NVH patients <60 yr old. Our results suggest that patients with VH should be investigated regardless of age. Although the risk of urinary tract cancer in NVH patients is low, clinically significant cancers are detected below the age threshold for referral for investigation. Patient summaryThis study highlights the requirement to investigate all patients with visible blood in the urine and an age threshold of ≥60 yr, as recommended in some guidelines, as the investigation of nonvisible blood in the urine will miss a significant number of urinary tract cancers. Patient preference is important, and evidence that patients are willing to submit to investigation should be considered in reaching a consensus recommendation for the investigation of haematuria. International consensus to guide that patients will benefit from investigation should be developed.

MP06-08 WHO SHOULD BE EVALUATED FOR HEMATURIA? A COMPARISON OF INTERNATIONAL GUIDELINES

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2018MP06-08 WHO SHOULD BE EVALUATED FOR HEMATURIA? A COMPARISON OF INTERNATIONAL GUIDELINES Wei Shen Tan, Andrew Feber, Liqin Dong, Rachael Sarpong, Simon Rodney, Pramit Khetrapal, Patricia de Winter, Rumana Jalil, Norman Williams, Chris Brew-Graves, John Kelly, and DETECT I trial group Wei Shen TanWei Shen Tan More articles by this author , Andrew FeberAndrew Feber More articles by this author , Liqin DongLiqin Dong More articles by this author , Rachael SarpongRachael Sarpong More articles by this author , Simon RodneySimon Rodney More articles by this author , Pramit KhetrapalPramit Khetrapal More articles by this author , Patricia de WinterPatricia de Winter More articles by this author , Rumana JalilRumana Jalil More articles by this author , Norman WilliamsNorman Williams More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , John KellyJohn Kelly More articles by this author , and DETECT I trial groupDETECT I trial group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ematuria is associated with an increased risk for urinary tract cancer (UTC). The American Urology Association (AUA) recommendation is that any patient presenting with gross haematuria (GH) and patients aged ≥ 35 years with asymptomatic microscopic hematuria (MH) should be investigated. The UK National Institute for Health and Care Excellence (NICE) recommended that patients aged ≥ 45 years with GH and ≥ 60 years with unexplained MH with either dysuria or a raised white cell count on blood test should be investigated. In this multicentre study, we compared hematuria guidelines to determine the appropriate age-dependent threshold for investigations. W also determined the incidence of bladder cancer, upper tract tumours and clinical-pathological characteristics according to type of hematuria. METHODS DETECT I (clinicaltrials.gov NCT02676180) is a multicentre observational study to determine the diagnostic accuracy of a urinary biomarker test for the detection of bladder. The study recruited patients refereed from primary care to any of 40 hospitals following a presentation of hematuria. All patients had a cystoscopy and upper tract imaging. Patients with a suspicion of bladder cancer had transurethral resection of bladder cancer or bladder biopsy for histological confirmation of cancer. RESULTS 3561 patients with a median age of 68 years were recruited over a 14-month period. GH represents 65% of patients referred for investigations. GH, increasing age, male patients and smoking history were independently associated with a diagnosis of UTC (all ≤0.05) on multiple logistic regression. The overall incidence of UTC was 10% (bladder cancer: 8.0%, renal parenchymal cancer 1.1%, Upper tract transitional cell carcinoma (TCC): 0.7%). The AUA guidance would identify all patients diagnosed with UTC in this patient cohort. Adopting the NICE guidance would miss 11 UTC (10 bladder cancers, 1 upper tract TCC). This represents 3.5% of bladder cancers and 3.8% of upper tract TCC. 70% of bladder cancers missed are intermediate to high risk disease including one ≥pT2 cancer. Of the 11 UTC missed, 4 missed bladder cancers presented with MH. 61% of patients presenting with MH have high risk bladder cancer with 32% of them ≥pT2. CONCLUSIONS Applying the NICE criteria to select patients for hematuria investigation will miss a significant number of cancers including those with clinically significant disease. The AUA guidance will identify all UTC in this study. Hematuria investigations cannot be safely avoided in patients with GH regardless of age and those ≥ 35 years with MH. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e54-e55 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wei Shen Tan More articles by this author Andrew Feber More articles by this author Liqin Dong More articles by this author Rachael Sarpong More articles by this author Simon Rodney More articles by this author Pramit Khetrapal More articles by this author Patricia de Winter More articles by this author Rumana Jalil More articles by this author Norman Williams More articles by this author Chris Brew-Graves More articles by this author John Kelly More articles by this author DETECT I trial group More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Are alarm symptoms predictive of cancer survival?

BackgroundAlarm symptom presentations are predictive of cancer diagnosis but may also be associated with cancer survival.AimTo evaluate diagnostic time intervals, and consultation patterns after presentation with alarm symptoms, and their association with cancer diagnosis and survival.Design and settingCohort study using the Clinical Practice Research Database, with linked Cancer Registry data, in 158 general practices.MethodParticipants included those with haematuria, haemoptysis, dysphagia, and rectal bleeding or urinary tract cancer, lung cancer, gastro-oesophageal cancer, and colorectal cancer.ResultsThe median (interquartile range) interval in days from first symptom presentation to the corresponding cancer diagnosis was: haematuria and urinary tract cancer, 59 (28–109); haemoptysis and lung cancer, 35 (18–89); dysphagia and gastro-oesophageal cancer, 25 (12–48); rectal bleeding and colorectal cancer, 49 (20–157). Three or more alarm symptom consultations were associated with increased odds of diagnosis of urinary tract cancer (odds ratio [OR] 1.84, 95% CI = 1.50 to 2.27), lung cancer (OR = 1.76, 95% CI = 1.07 to 2.90) and gastro-oesophageal cancer (OR = 2.17, 95% CI = 1.48 to 3.19). Longer diagnostic intervals were associated with increased mortality only for urinary tract cancer (hazard ratio 2.23, 95% CI = 1.35 to 3.69). Patients with no preceding alarm symptom had shorter survival from diagnosis of urinary tract, lung or colorectal cancer than those presenting with a relevant alarm symptom.ConclusionAfter alarm symptom presentation, repeat consultations are associated with cancer diagnoses. Longer diagnostic intervals appeared to be associated with a worse prognosis for urinary tract cancer only. Mortality is higher when cancer is diagnosed in the absence of alarm symptoms.

A population study of neutering status as a risk factor for canine prostate cancer

Prostate cancer has been reported to occur more commonly in neutered than intact male dogs in several case series. This study was undertaken to evaluate risk of prostate cancer in a large population database. The hypothesis was that castration is a risk factor for prostate cancer in male companion dogs. Data were derived from recorded visits to North American veterinary teaching hospitals. The Veterinary Medical Databases (VMDB) were queried to yield male dogs with urinary bladder transitional cell carcinoma (TCC), prostate adenocarcinoma (ACA), prostate TCC, prostate carcinoma (CA), and prostate tumors. A second query yielded all male dogs over the age of 4 years without a diagnosis of urinary tract cancer. These populations were compared to determine relative risks for developing each disease, singly and collectively, associated with neutering status. Odds ratios were calculated for breed as a risk factor. Neutered males had a significantly increased risk for each form of cancer. Neutered males had an odds ratio of 3.56 (3.02-4.21) for urinary bladder TCC, 8.00 (5.60-11.42) for prostate TCC, 2.12 (1.80-2.49) for prostate adenocarcinoma, 3.86 (3.13-4.16) for prostate carcinoma, and 2.84 (2.57-3.14) for all prostate cancers. Relative risks were highly similar when cases were limited to those with a histologically confirmed diagnosis. Breed predisposition suggests that genetic factors play a role in the development of prostate cancer. The risk associated with being neutered is highest for TCC, supporting previous work identifying the urothelium and ductular rather than acinar epithelium as the source of these tumors.

尿路上皮癌に対する尿中腫瘍マーカー（BTAtest・ BFP・NMP22)の有用性についての検討

尿路上皮癌に対する尿中腫瘍マーカー（BTAtest・ BFP・NMP22)の有用性についての検討

Study of normal and cancerous urine using photoacoustic spectroscopy

Photoacoustic spectroscopy (PAS) is a valuable technique, increasingly applied in clinical and biological analysis. Light absorption properties of urine and body tissue can be obtained more easily by the PAS technique because of its high sensitivity, than by the conventional optical techniques. By observing their absorption properties it is possible to diagnose some diseases and in this study we have used PAS to assess cancerous changes in urine and tissue. Three groups were studied: normal individuals; patients with cancer; and patients with cancer and subsequent inflammation; and the characteristic light absorption peaks obtained for a certain band (240–420 nm). These results were compared with the clinical diagnosis and proved consistent and reliable for the diagnosis of urinary tract cancer subsequently confirmed by operation. This method will probably be a useful tool for the early clinical diagnosis of cancer of the urinary system.

The Photography of Retinal Impressions

<h3>Background</h3> Alarm symptom presentations are predictive of cancer diagnosis but may also be associated with cancer survival. <h3>Aim</h3> To evaluate diagnostic time intervals, and consultation patterns after presentation with alarm symptoms, and their association with cancer diagnosis and survival. <h3>Design and setting</h3> Cohort study using the Clinical Practice Research Database, with linked Cancer Registry data, in 158 general practices. <h3>Method</h3> Participants included those with haematuria, haemoptysis, dysphagia, and rectal bleeding or urinary tract cancer, lung cancer, gastro-oesophageal cancer, and colorectal cancer. <h3>Results</h3> The median (interquartile range) interval in days from first symptom presentation to the corresponding cancer diagnosis was: haematuria and urinary tract cancer, 59 (28–109); haemoptysis and lung cancer, 35 (18–89); dysphagia and gastro-oesophageal cancer, 25 (12–48); rectal bleeding and colorectal cancer, 49 (20–157). Three or more alarm symptom consultations were associated with increased odds of diagnosis of urinary tract cancer (odds ratio [OR] 1.84, 95% CI = 1.50 to 2.27), lung cancer (OR = 1.76, 95% CI = 1.07 to 2.90) and gastro-oesophageal cancer (OR = 2.17, 95% CI = 1.48 to 3.19). Longer diagnostic intervals were associated with increased mortality only for urinary tract cancer (hazard ratio 2.23, 95% CI = 1.35 to 3.69). Patients with no preceding alarm symptom had shorter survival from diagnosis of urinary tract, lung or colorectal cancer than those presenting with a relevant alarm symptom. <h3>Conclusion</h3> After alarm symptom presentation, repeat consultations are associated with cancer diagnoses. Longer diagnostic intervals appeared to be associated with a worse prognosis for urinary tract cancer only. Mortality is higher when cancer is diagnosed in the absence of alarm symptoms.