There is much information on the genetic alterations that contribute to the
development of bladder cancer. Because it is hypothesised that the genotyp
e of the cancer cell plays a major role in determining phenotype, this gene
tic information should impact on clinical practice. To date however, this h
as not happened. Some of the alterations identified in bladder cancer have
clear associations with outcome for example, mutational inactivation of the
cell cycle regulator proteins p53 and the retinoblastoma protein (Rb). How
ever, as single markers, these events have insufficient predictive power to
be applied in the management of individual patients. The use of panels of
markers is a potential solution to this problem. Examples of suitable panel
s include those genes/ proteins with known impact on specific cell cycle ch
eckpoints or with impact on cellular phenotypes, such as immortalisation, i
nvasion, or metastasis. To evaluate such marker panels, large tumour series
will be needed-for example, archival samples from completed clinical trial
s. The use of these valuable resources will require coordination of sample
provision. This might involve central collection and distribution of tissue
blocks, sections, or tissue arrays and the provision of patient follow up
information to laboratories participating in a study. With the availability
of microarray technologies, including cDNA and comparative genomic hybridi
sation arrays, the transcriptome and genome of transitional cell carcinomas
of different phenotypes can be compared and will undoubtedly provide a wea
lth of information with potential diagnostic and prognostic uses. Although
these studies can be initiated using small local tissue collections, high q
uality collection of fresh tissues from new clinical trials will be crucial
for proper evaluation of associations with clinical outcome. Funding for m
olecular pathological studies to date has been poor. To begin to translate
molecular information from the laboratory to the clinic and to make maximum
use of valuable urological patient resources in the UK, adequate funding a
nd scientific energy are required. Whereas the latter is not in doubt, pres
ent funding for this type of translational research is inadequate.