The importance urinary glycosaminoglycan as a marker for superficial bladder tumors

Urinary glycosaminoglycan/creatinine ratio (GAG/Cr) was determined in 42 patients with superficial bladder tumors (before and after the treatment) and in 34 healthy subjects. Before the treatment, the mean GAG/Cr ratio in patients group was not significantly different from the control group's figure (11.65 +/- 3.25 and 10.11 +/- 2.67). However, comparison of urinary GAG levels of T1 and Grade III tumors with the control group revealed statistically significant results (p<0.01 and p<0.001, respectively). All patients were previously operated by transurethral resection (TUR) and then intravesical chemotherapy applied [(BCG (n:20), 4-epidoxorubicin (n:12), interferon alpha-2 (n:10)]. Three months after the treatment, urinary GAG levels were determined. In 19 of the 24 patients whose pretreatment urinary GAG levels were higher than the control group, tumor completely remitted and their urinary GAG excretion decreased. The tumors of three cases gradually progressed and their GAG excretions were normal. Two cases hadn't any tumor mass and their urinary GAG excretion was higher than the pretreatment levels. The remaining 18 patients didn't show any clinical modification and their urinary GAG excretion did not differ from the control's and pretreatment levels. The results indicated that this test can be used as a noninvasive adjunct procedure in the follow up of patients with bladder tumors, and that urinary GAG level can not be considered as an ideal marker for bladder tumor.