TY - JOUR
T1 - Considerations on the use of urine markers in the management of patients with low-/intermediate-risk non-muscle invasive bladder cancer
AU - Schmitz-Dräger, Bernd J.
AU - Todenhöfer, Tilman
AU - van Rhijn, Bas
AU - Pesch, Beate
AU - Hudson, Mĺiss A.
AU - Chandra, Ashish
AU - Ingersoll, Molly A.
AU - Kassouf, Wassim
AU - Palou, Joan
AU - Taylor, John
AU - Vlahou, Antonia
AU - Behrens, Thomas
AU - Critelli, Rossana
AU - Grossman, H. Barton
AU - Sanchez-Carbayo, Marta
AU - Kamat, Ashish
N1 - Publisher Copyright:
© 2014 Elsevier Inc.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objectives: 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.
AB - Objectives: 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.
KW - Costs
KW - Disease management
KW - Low risk
KW - Non-muscle invasive bladder cancer
KW - Urine markers
UR - http://www.scopus.com/inward/record.url?scp=84920531742&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84920531742&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2013.10.010
DO - 10.1016/j.urolonc.2013.10.010
M3 - Review article
C2 - 24411790
AN - SCOPUS:84920531742
SN - 1078-1439
VL - 32
SP - 1061
EP - 1068
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 7
ER -