Urine detection of survivin and diagnosis of bladder cancer

Context Dysregulation of apoptosis may favor onset and progression of cance r and influence response to therapy. Survivin is an inhibitor of apoptosis that is selectively overexpressed in common human cancers, but not in norma l tissues, and that correlates with aggressive disease and unfavorable outc omes, Objective To investigate the potential suitability of survivin detection in urine as a novel predictive/prognostic molecular marker of bladder cancer, Design, Setting, and Patients Survey of urine specimens from 5 groups: heal thy volunteers (n=17) and patients with nonneoplastic urinary tract disease (n=30), genitourinary cancer (n=30), new-onset or recurrent bladder cancer (n=46), or treated bladder cancer (n=35), recruited from 2 New England uro logy clinics. Main Outcome Measures Detectable survivin levels, analyzed by a novel detec tion system and confirmed by Western blot and reverse transcriptase polymer ase chain reaction (RT-PCR), in urine samples of the 5 participant groups. Results Survivin was detected in the urine samples of all 46 patients with new or recurrent bladder cancer using a novel detection system (31 of 31) a nd RT-PCR (15 of ? 5) methods. Survivin was not detected in the urine sampl es of 32 of 35 patients treated for bladder cancer and having negative cyst oscopy results. None of the healthy volunteers or patients with prostate, k idney, vaginal, or cervical cancer had detectable survivin in urine samples , Of the 30 patients with nonneoplastic urinary tract disease, survivin was detected in 3 patients who had bladder abnormalities noted using cystoscop y and in 1 patient with an increased prostate-specific antigen level. Patie nts with low-grade bladder cancer had significantly lower urine survivin le vels than patients with carcinoma in situ (P=.002). Conclusions Highly sensitive and specific determination of urine survivin a ppears to provide a simple, noninvasive diagnostic test to identify patient s with new or recurrent bladder cancer.