Urothelial cancer biomarkers for detection and surveillance

Cancer is a complex process, and the US cancer-specific death rate has not changed in the last 50 years. Cure of the disease usually results from early diagnosis and treatment. Urothelial carcinoma (UC) has the highest recurrence rate of any cancer and is the second most common cancer of the genitourinary tract. It usually does not present at a metastatic stage, but only 50% of patients treated with cystectomy survive > or =5 years. There is a UC surveillance protocol, which includes cystoscopy, imaging, and cytology, to detect progression and allow early treatment of life-threatening UC. Many patients may not complete the surveillance protocol, and the cost of these studies is increasing. In addition, questions about the efficacy of these modalities have been raised. Therefore, bladder urinary tumor markers have been developed to aid in the diagnosis and surveillance of UC. Because urothelial cells are bathed in the urine and are continually shed, UC presents a unique opportunity to monitor bladder neoplasia in a noninvasive fashion. Currently, there are many research bladder tumor markers, but only a few are commercially available US Food and Drug Administration (FDA)-approved products. The commercially available bladder tumor markers and potential future markers are discussed. The ideal urinary bladder tumor test is still unavailable, but the eventual "gold standard" will consist of multiplex assays that analyze nucleic acids and proteins for detection. In addition, these tests would also reveal to the clinician both prognostic information and therapeutic targets for personalized medical treatment.