title: Considerations on the use of urine markers in the management of patients with high-grade non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  Diagnosis and surveillance of high risk non muscle-invasive bladder cancer (NMIBC) represent specific challenges to urologists. In contrast to low/intermediate risk tumors, these tumors recur more frequently. A significant number will eventually progress to muscle-invasive bladder cancer, a life threatening disease requiring extensive therapeutic efforts. Although clinical risk factors have been identified that may predict tumor recurrence and progression, additional biomarkers are desperately needed to improve tumor diagnosis and guide clinical management of these patients. In this article, the role of molecular urine markers in the management of high risk NMIBC is analyzed.
  
  
  METHODS
  In this context, several potential indications (diagnostic, prognostic, predictive) were identified and the requirements for molecular markers were defined. In addition, current knowledge within the different indications was summarized.
  
  
  RESULTS
  Significant progress has been made in the last decade studying the impact of molecular urine markers in patients with high risk NMIBC.
  
  
  CONCLUSIONS
  Although we may not be ready for the inclusion of molecular markers in clinical decision-making, and many questions remain unanswered, recent studies have identified situations in which the use of molecular markers in particular in high grade tumors may prove beneficial for patient diagnosis and surveillance.
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.affiliation: Division of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Vlahou
authors.affiliation: Division of Urology, University of Connecticut Health Center, Farmington, CT.
authors.forename: John A
authors.initials: JA
authors.lastname: Taylor
authors.affiliation: Ochsner Clinic Foundation, Tom and Gayle Benson Cancer Center, New Orleans, LA.
authors.forename: M' Liss A
authors.initials: ML
authors.lastname: Hudson
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: Department of Immunology, Institut Pasteur and U818 Inserm, Paris, France.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Ingersoll
authors.affiliation: Urologische Universitätsklinik, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Tilmann
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: McGill University Health Center, Montreal, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: H
authors.initials: H
authors.lastname: Barton Grossman
authors.affiliation: Protein Research Unit Ruhr within Europe (PURE), Ruhr-Universität, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Behrens
authors.affiliation: Cellular Pathology, St Thomas׳ Hospital, London, UK.
authors.forename: Ashish
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Urologische Klinik, Friedrich-Alexander-Universität, Erlangen, Germany.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goebell
authors.affiliation: Servicio de Urología, Fundación Puigvert, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Palou
authors.affiliation: CIC bioGUNE, Bilbao, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sanchez-Carbayo
authors.affiliation: Urologie Schön Klinik Nürnberg Fürth/Urologie, Fürth, Germany. Electronic address: bernd_sd@yahoo.de.
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Schmitz-Dräger
mesh_terms: D014408:Biomarkers, Tumor / Q000652:urine*; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000652:urine*
chemical_list: D014408:Biomarkers, Tumor
keywords: Diagnosis; Disease management; High grade; Non–muscle-invasive bladder cancer; Urine markers