Bladder cancer

There is a need for the development of reliable tumor markers in bladder ca ncer. A number of studies this past year focused on the evaluation of urina ry markers that hold promise as noninvasive adjuncts to traditional diagnos tic or surveillance techniques, principally urinary cytology and cystoscopy . Tests for bladder tumor antigen, NMP22, and fibrin degradation products, as well as the Immunocyt test, are commercially available. Other urinary ma rker tests discussed in this review include telomerase, cytokeratins, and v ascular endothelial growth factor, Although these tests in many instances h ave improved sensitivity in detecting bladder cancer compared with urinary cytology, none have become widely accepted in routine clinical practice. No netheless, with further refinement and prospective validation in multicente r trials, markers such as these may provide information that would permit t ailoring on an individual basis the type of as well as interval of surveill ance examinations. Furthermore, they may also provide information allowing the appropriate selection of therapy based on predicted response. in additi on to urinary markers, intense research efforts have also focused on develo ping clinically useful molecular prognostic markers. A number of cell-cycle regulatory proteins, including p53 and p21, have received much attention i n this regard. Emerging data suggests that it may soon be possible to deter mine the molecular phenotype of both superficial and invasive bladder cance rs, thereby providing information regarding tumor behavior on an individual basis. As with urinary markers, however, no molecular markers have been in corporated as yet into day-to-day patient care. Assurances of reproducibili ty, standardization, and prospective validation studies are urgently needed . It is only through this type of rigorous evaluation that the level of con fidence sufficient to base treatment decisions on marker status will be att ained. Curr Opin Oncol 2000, 12:255-259 (C) 2000 Lippincott Williams & Wilk ins, Inc.