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New Approach to Screening for Bladder Cancer?

A new urine biomarker assay might improve the yield of bladder cancer screening.

The incidence of bladder cancer has increased substantially in recent decades. However, screening methods for bladder cancer are either insensitive (urine cytology) or too invasive (cystoscopy) to be used widely. Successful pilot studies of a new method, a urine telomerase activity assay, led Italian investigators to evaluate the accuracy of this method in a case-control study. Using a telomeric repeat amplification protocol (TRAP) and a predetermined cutoff of 50 arbitrary enzymatic units (AEUs), they assessed urine from 134 men with known bladder cancer (cases) and 84 healthy men (controls).

All cases underwent cystoscopy, and cytology results were available for 103 (48 positives; sensitivity, 47%). About half of the cases had moderately differentiated or well-differentiated tumors, and half had poorly differentiated tumors. Cytology results were available for all controls. The mean TRAP assay results for controls and cases were 27 AEUs and 112 AEUs, respectively. The overall sensitivity of TRAP was 90%, and its specificity was 88%; for younger patients (75), specificity was 94%.

Comment: These results are encouraging, but prospective studies in larger unselected patient populations are necessary before the TRAP assay can be used clinically. Eventually, it might be most useful in screening high-risk patients, such as smokers.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine November 1, 2005

Citation(s):

Sanchini MA et al. Relevance of urine telomerase in the diagnosis of bladder cancer. JAMA 2005 Oct 26; 294:2052-6.

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