Current concepts in biomarker technology for bladder cancers

Background: Transitional cell carcinoma of the bladder (TCC) is the second most common malignancy of the urinary tract. More than 70% of treated tumor s recur, and 30% of recurrent tumors progress. Currently, pathologic stagin g and grading are valuable prognostic factors for detecting and monitoring TCC. Urinalysis, cystoscopy, and cytology are either invasive or lack sensi tivity and specificity. The availability of a noninvasive, reliable, and si mple test would greatly improve the detection and monitoring of patients wi th TCC. Several biomarkers for bladder cancer have been proposed, but no si ngle marker has emerged as the test of choice. Approach: We undertook a comprehensive literature search using Medline to i dentify all publications from 1980 to 1999. Articles that discussed potenti al biomarkers for TCC were screened. Only compounds that demonstrated high sensitivity or specificity, significant correlation with TCC diagnosis and staging, and extensive investigation were included in this review. Content: Potential biomarkers of disease progression and prognosis include nuclear matrix protein, fibrin/fibrinogen product, bladder tumor antigen, b lood group-related antigens, tumor-associated antigens, proliferating antig ens, oncogenes, growth factors, cell adhesion molecules, and cell cycle reg ulatory proteins. The properties of the biomarkers and the methods for dete cting or quantifying; them are presented. Their sensitivities and specifici ties for detecting and monitoring disease were 54-100% and 61-97%, respecti vely, compared with 20-40% and 90% for urinalysis and cytology. Summary: Although urine cytology and cystoscopy are still the standard of p ractice, many candidate biomarkers for TCC are emerging and being adopted i nto clinical practice. Further research and better understanding of the bio logy of bladder cancer, improved diagnostic techniques, and standardized in terpretation are essential steps to develop reliable biomarkers. It is poss ible that using the current biomarkers as an adjuvant modality will improve our ability to diagnose and monitor bladder cancer. (C) 2000 American Asso ciation for Clinical Chemistry.