Tumor markers in the detection of recurrent transitional cell carcinoma ofthe bladder - A brief review

OBJECTIVE: To determine the status of the most promising tumor makers of bl adder cancer, including comparison with cytology, technical complexity and utility in patient management. STUDY DESIGN: An extensive literature search was performed, and multiple ma rkers were evaluated. The markers with the greatest potential for rise as a n adjunct to cytology were reviewed to determine the value of clinical impl ementation. Markers with a paucity of clinical research and poor results in clinical trials were omitted from review, as were genetic and cytologic pr ognostic determinants. RESULTS: NMP22, bladder tumor antigen, fibrin/ fibrinogen degradation produ cts, telomerase and QUANTICYT image analysis cytometry produced the most fa vorable and reproducible results. Each test obtained favorable sensitivitie s in comparison with cytology, especially in the detection of low grade les ions. Many also retrospectively placed patients in high- and low-risk group s based on the test results, allowing increased follow-up time between cyst oscopies. However, inability to detect some high grade lesions reduces thei r utility. CONCLUSION: Continued clinical trials using these and other predictors of b ladder cancer will eventually find a test that is suitable, in sensitivity and specificity, for use in urology clinics. Until that time, these tests m ay be useful in conjunction With cytology to prolong the interval between c ystoscopies.