What is the current status of bladder tumor markers?

  • İbrahim Dönmez
  • N. Aydın Mungan

Bull Urooncol 2012;11(1):19-26

Bladder cancer continues to be a major health problem despite all advances in the field. As an invasive procedure, cystoscopy, is an indispensible step for diagnosis and surveillance of bladder cancer. Urinary cytology has been used to aid in diagnosis, but its use is limited. Urine cytology has reasonable sensitivity and specificity for the detection of high-derece bladder cancer, but sensitivity for detection of low-derece tumors ranges only from 4% to 31%. In recent years, numerous urinary markers detected for diagnosis and surveilance for bladder cander. The aim of these markers to reduce the number of invasive cystoscopies for diagnosis and surveilance for bladder cancer and to overcome insuffiency or even supersede cytology.

The ultimate goal is the development of urinary markers that have high negative and positive predictive values (NPV and PPV) which are better determinant than high sensitivity and specificity for bladder cancer. However, many studies in the literature evaluated urinary markers without taking into consideration of their NPV and PPV's. As a result of that, thousands of urinary markers have been evaluated and, althought some promising results, none of them currently have been used in daily practise. An ideal urine marker for bladder cancer should reliably detect bladder cancer and it might also reduce the number of cystoscopies in surveillance of non–muscle-invasive bladder cancer. For this purpose, there are commercially available markers such as NMP22, FISH, BTA and Immunocyt as well as experimental markers. Although, developed urinary markers have been shown to have higher sensitivity than cytology by many studies, these markers are far from being ideal and they cannot safely replace cystoscopy in this setting in near future.

This review is aimed to review the currently available urinary bladder cancer markers as well as investigational urinary markers for future clinical use.

Keywords: urinary cytology, urinary markers, FISH, telomerase, microsatellite analysis