Update on urine-based markers for bladder cancer. How sensitive and specific are the new noninvasive tests?

Urine cytology is still the most commonly used noninvasive test to diagnose bladder cancer. However, cytology's ability to detect low-grade bladder tumors is limited, and its results require interpretation by a pathologist, are not available immediately, and are subjective. Several noninvasive urine-based tests are now available for detection and follow-up of bladder cancer. At least two of these new tests (BTA stat and AuraTek FDP) can easily be performed in the office, and the results are available in about 10 minutes. When choosing a test, physicians should keep in mind that none of the currently available tests is 100% accurate. However, the new urine-based tests are more sensitive than urine cytology and hence more reliable in detecting low-grade bladder cancer. They are useful tools in patients with urinary symptoms or microscopic hematuria or as office-based adjuncts to diagnostic procedures. Some of the markers that are being developed could significantly improve and simplify workup, diagnosis, and follow-up, and they may allow for detection of disease at an earlier stage, thus improving the chances of curative therapy.