You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20101167 DETECTION OF VOIDED URINARY PROSTATE STEM CELL ANTIGEN AS A HIGHLY SENSITIVE MARKER FOR UROTHELIAL TRANSITIONAL CELL CARCINOMA Sevan Stepanian, Jessica Chan, Benjamin Shurtleff, Mary Levin, Arnold Chin, Rao Jianyu, and Robert Reiter Sevan StepanianSevan Stepanian More articles by this author , Jessica ChanJessica Chan More articles by this author , Benjamin ShurtleffBenjamin Shurtleff More articles by this author , Mary LevinMary Levin More articles by this author , Arnold ChinArnold Chin More articles by this author , Rao JianyuRao Jianyu More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate stem cell antigen (PSCA) is overexpressed in human prostate, pancreas, and bladder cancers. Recently a common missense mutation has implicated PSCA in susceptibility to the development of urothelial transitional cell carcinoma (TCC) of the bladder. The current use of voided urine cytology as an adjunct marker for TCC provides poor sensitivity for detecting low grade papillary TCC. Here, we investigate the use of voided immunocytochemical staining of PSCA to increase the sensitivity of traditional cytology in detecting low grade TCC. METHODS Immunocytochemical analysis was retrospectively performed on voided cytological specimens from the UCLA pathology database from February 2004 to March 2006. Specimens from 91 patients included in the study were stained and scored for PSCA. Sensitivity and specificity of voided cytology results and PSCA score were compared using a paired student's T-test. Forty-six of the 91 patients with no history of TCC served as negative controls, and were randomly selected from the same database. Of the 45 patients with biopsy proven bladder cancer, 60% were Ta or CIS, 20% T1, and 20% T2-4 disease, with 62% low grade carcinomas. RESULTS The sensitivity and specificity of cytology alone was 44.4% and 100% respectively. Staining for PSCA alone attained a sensitivity of 84.4% and a specificity of 87.0%, improving the sensitivity of cytology alone by 40% (p<0.001). The combination of cytology and PSCA only slightly increased sensitivity to 86.7% with a specificity of 87.0%. Furthermore, PSCA was markedly more sensitive at detecting low-grade TCC at 78.6% versus 28.6% compared to cytology alone (p<0.0001). A trend towards improving the sensitivity of detecting high-grade TCC was observed comparing PSCA to cytology. Interestingly, of the seven false negatives, we obtained tumor blocks from five of these patients, none of which stained positive for PSCA. A reduction in specificity was noted in the PSCA group when compared to cytology (p=0.013). CONCLUSIONS In our retrospective series, urinary detection of PSCA by immunocytochemistry enhances the detection of low grade TCC. The sensitivity and specificity of PSCA alone is similar to the combination of PSCA and cytology. PSCA detection can be performed simultaneously with cytology on urine specimens, or can be performed retrospectively on archived samples. Future multi-institutional studies will need to validate PSCA as a surveillance marker. Los Angeles, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e452 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sevan Stepanian More articles by this author Jessica Chan More articles by this author Benjamin Shurtleff More articles by this author Mary Levin More articles by this author Arnold Chin More articles by this author Rao Jianyu More articles by this author Robert Reiter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...