title: Replacing cystoscopy by urine markers in the follow-up of patients with low-risk non-muscle-invasive bladder cancer?-An International Bladder Cancer Network project.
abstract: Numerous molecular urine markers for the diagnosis of bladder cancer have been developed and evaluated mostly in case-control settings through the past decades. However, despite all efforts none of them has been included into clinical decision-making and guideline recommendations until today. The aim of this retrospective longitudinal analysis was to investigate if a molecular marker might be able to replace cystoscopy as a primary examination in diagnosis and follow-up of patients with pTa grade 1-2 bladder cancer.
  
  
  
  Totally 36 patients (32 men) with pTa grade 1-2 bladder cancer underwent 232 follow-up examinations including urine analysis, cytology, immunocytology (uCyt+), and urethrocystoscopy (UC). Mean age at study entry was 63 years. Patients were observed through a median follow-up interval of 3.8 years.
  
  
  
  In summary, 47 Transurethral Resection of Bladder Tumors (TURB) procedures were indicated based upon a positive UC (44) or as re-TURB (3) and 33 tumors (plus 1 case of pTa G0) were histopathologically confirmed. Although uCyt+was positive in 12/13 primary tumors (92.3%), sensitivity dropped to 13/20 (65%) in tumor recurrence presumably because of their smaller size. Urine cytology had a sensitivity and a specificity of 30.3% and 94.9%, respectively, but did not improve the sensitivity of uCyt+alone. If UC was based upon a positive uCyt+test, 8/33 tumors (24.2%) would have been overlooked or diagnosed late. In contrast, 173 UCs (74%) would have been saved and 5 presumably unnecessary TURB procedures would not have been indicated.
  
  
  
  This longitudinal study suggests a potential of molecular urine tests in replacing cystoscopy in the follow-up of patients with pTa G1-2 bladder cancer. The use of additional markers might further improve sensitivity of urine testing. A prospective randomized study has been initiated to prospectively investigate the performance of a marker panel against UC.
authors.affiliation: Urologie(24)/Urologie Schön Klinik Nürnberg Fürth, Fürth, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmitz-Dräger
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr University Bochum (IPA), Bochum, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Bonberg
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr University Bochum (IPA), Bochum, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Pesch
authors.affiliation: Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.affiliation: Urologie(24)/Urologie Schön Klinik Nürnberg Fürth, Fürth, Germany.
authors.forename: Sevim
authors.initials: S
authors.lastname: Sahin
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr University Bochum (IPA), Bochum, Germany; Protein Research Unit Ruhr Within Europe (PURE), Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Behrens
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr University Bochum (IPA), Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brüning
authors.affiliation: Urologie(24)/Urologie Schön Klinik Nürnberg Fürth, Fürth, Germany; Department of Urology, Friedrich-Alexander University, Erlangen, Germany. Electronic address: bernd_sd@yahoo.de.
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Schmitz-Dräger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000652:urine*; D003558:Cystoscopy; D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000652:urine*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D047368:Tumor Burden; D016482:Urinalysis; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000652:urine*; D014556:Urine / Q000737:chemistry / Q000166:cytology
chemical_list: D014408:Biomarkers, Tumor
keywords: Cystoscopy; Disease management; Follow-up; Immunocytology; Non–muscle-invasive bladder cancer; TURB; Urine cytology; Urine markers