Biomarkers for bladder cancer aggressiveness

Bladder cancer is associated with high recurrence and mortality rates. Development of accurate surveillance tests to evaluate disease aggressiveness and for prognosis of disease recurrence and progression is a major clinical need. At the molecular level bladder cancer displays a vast heterogeneity as reflected by the presence of multiple potential biomarkers associated with various disease phenotypes. The scope of this review is to briefly summarize the latest findings on biomarkers potentially beneficial in disease stratification based on aggressiveness and prognosis.

Multiple potential biomarkers for bladder cancer have been identified corresponding to chromosome, DNA, and epigenetic alterations, as well as changes in RNA, miRNAs, and protein expression levels and modifications. We summarize some of the main biomarker findings reported in the past year that are considered to be potentially correlated to disease aggressiveness. A comparison to existing latest evidence from the classical US Food and Drug Administration-approved bladder cancer detection markers is made.

Potential biomarkers detected noninvasively in urine specimens, as well as in excised tissue specimens following initial treatment, are briefly reported. The prognostic information provided may be significant, as multiple markers by now have been found to correlate with disease outcome. However, the studies presented were in general either too small, and/or the performance of the single biomarkers was moderate. The information presently available suggests that single biomarkers may be insufficient for effective monitoring and patient management. A concerted effort to establish panels of biomarkers based on the ample existing knowledge, and validate them in proper clinical trials is urgently needed.