title: Considerations on the use of urine markers in the management of patients with low-/intermediate-risk non-muscle invasive bladder cancer.
abstract: OBJECTIVE
  Many molecular assays for bladder cancer diagnosis and surveillance have been developed over the past several decades. However, none of these markers have been routinely implemented into clinical decision making. Beyond their potential for screening high-risk populations, urine markers likely have the greatest potential in the follow-up of patients with non-muscle invasive bladder cancer (NMIBC).
  
  
  METHODS
  Here, we discuss the current options and limitations of the use of urine markers for patient surveillance, focusing on patients with low-/intermediate-risk NMIBC.
  
  
  RESULTS
  As these patients have a very low risk of tumor progression, the primary goal of surveillance is detection of recurrent disease. Although urine cytology seems to be limited to detection of few patients who would develop high-grade tumors, we conclude that the use of markers with high sensitivity for low-grade disease for patient follow-up has the potential to decrease the frequency of urethrocystoscopy without compromising patient prognosis. Because a single marker may not have sufficient sensitivity for detection of low-grade tumors, different scenarios, e.g., multitesting and reflex or sequential approaches, are discussed.
  
  
  CONCLUSIONS
  There is consensus that currently available markers have the potential to support clinical decision making in follow-up of patients with low-/intermediate-risk NMIBC. In light of our analysis, further additional randomized controlled studies to effectively assess the clinical usefulness of modern urine markers are required.
authors.affiliation: Urologie24, Fürth, Germany; Schön Klinik Nürnberg/Fürth, Fürth, Germany. Electronic address: bernd_sd@yahoo.de.
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Schmitz-Dräger
authors.affiliation: Urologische Universitätsklinik, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.affiliation: Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: van Rhijn
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University, Bochum, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Pesch
authors.affiliation: Ochsner Clinic Foundation, Tom and Gayle Benson Cancer Center, New Orleans, LA.
authors.forename: Mĺiss A
authors.initials: MA
authors.lastname: Hudson
authors.affiliation: Cellular Pathology, St Thomas' Hospital, London, UK.
authors.forename: Ashish
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Department of Immunology, Institute Pasteur and U818 Inserm, Paris, France.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Ingersoll
authors.affiliation: McGill University Health Center, Montreal, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: Servicio de Urología, Fundación Puigvert, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.affiliation: Division of Urology, University of Connecticut Health Center, Farmington, CT.
authors.forename: John
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Division of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Vlahou
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University, Bochum, Germany; Protein Research Unit Ruhr within Europe (PURE), Ruhr-Universität, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Behrens
authors.affiliation: Department of Genetics, Biology and Biochemistry, Universita di Torino, Torino, Italy; HuGeF-Human Genetics Foundation, Torino, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Critelli
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.affiliation: CIC bioGUNE, Bilbao, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sanchez-Carbayo
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kamat
mesh_terms: D014408:Biomarkers, Tumor / Q000652:urine*; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000652:urine*
chemical_list: D014408:Biomarkers, Tumor
keywords: Costs; Disease management; Low risk; Non–muscle invasive bladder cancer; Urine markers