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AUA 2017

AUA 2017: Beyond Cytology: What is the Urinary Marker We Should Use Now and What Will Be the Best in the Future?

Boston, MA (UroToday.com) This was a very nice review of the successes and failures of non-invasive screening for bladder cancer. Bladder cancer is the optimal cancer for minimally invasive urinary biomarkers because of the bathing of urine by tumor cells. There are limitations and discomfort with cystoscopy, making bladder cancer a highly costly cancer to survey and treat. Ideal urinary biomarkers should be technically simple, specific/sensitive, affordable, and predict clinically important outcomes. Most of the cell-based assays have lower sensitivity for low-grade tumors since these tumors do not shed into the urine at the same rate as high grade CIS lesions. Cytology has been available since the 1940s, is well established and straightforward, is highly sensitive and specific for CIS/HG tumors, however it lacks sensitivity for low grade tumors. It is also plagued with vague outputs (indeterminate, atypical, suspicious) making interpretation and clinical decision making more complex and has led to investigation of alternatives. No single biomarker has succeeded, mostly due to low specificity, however perhaps a combination panel could increase specificity. She quickly reviewed the currently available biomarkers including NMP22, BTA, UroVysion (FISH), and ImmunoCyt all with sensitivities and specificities between 60% and 80%. She concluded by quickly describing a few of the newer sequencing-based assays with NPVs over 90% including CxBladderT, AssureMDx, Xpert® and others in the pipeline. This field is exploding with 65 trials in biomarkers in bladder cancer currently accruing. The challenge for clinicians will be determining how and when to use all of these tests.

Presented by: Kristen Scarpato, MD Vanderbilt University Medical Center

Contributed by: Jed Ferguson, MD/PhD and Ashish Kamat, MD. MD Anderson Cancer Center, Department of Urology.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA