Hyaluronic acid and hyaluronidase. Two new markers for bladder cancer

The heterogeneity of bladder cancer concerning progress or recurrence is an essential characteristic of th is disease. Hyaluronic acid (HA) and its de grading enzyme hyaluronidase (HAase) are intricately associated with bladde r cancer angiogenesis and metastasis. Tumor-associated HA and HAase are sec reted in urine. In 513 urine specimens (261 bladder cancer patients, 252 patients without b ladder cancer) and 83 bladder tissue specimens (71 bladder tumors, 12 norma l bladder tissues),the accuracy of HA and HAase as tumor markers was studie d. Elevated urinary HA levels (greater than or equal to 500 ng/ml),indicating a positive HA test, suggest the presence of regardless of tumor grade. Elevated urinary HAase levels (greater than or equal to 10 mU/mg) indicate high-grade (G2/G3) bladder cancer. The combined HA-HAase urine test sh owed 91% sensitivity and 84% specificity to detect bladder cancer. The HA-HAase test is equally sensitive for monitoring tumor recurrence. Immunohistochem istry (IHC) staining of HA and HAase in the G1 and G2/G3 bladder cancer spe cimens was significantly (p<0.001) higher than in normal bladder tissue. HA and HAase appear to be useful markers in the diagnosis of bladder cancer . When compared with other noninvasive tests, the HA-HAase urine test may b e less expensive and more accurate.