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Pichler R, Fritz J, Tulchiner G, Klinglmair G, Soleiman A, Horninger W, Klocker H, Heidegger I. Increased accuracy of a novel mRNA-based urine test for bladder cancer surveillance. BJU Int 2017; 121:29-37. [PMID: 28941000 DOI: 10.1111/bju.14019] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of the Xpert Bladder Cancer (BC) Monitor, compared with cystoscopy and cytology in the oncological follow-up of non-muscle-invasive bladder cancer (NMIBC). MATERIAL AND METHODS A total of 140 patients with a history of NMIBC undergoing routine surveillance at our institution were enrolled prospectively in this study (ISRCTN study registry number 37210907). Urine cytology was evaluated according to the Paris classification system. In addition, urinary specimens were analysed using the Xpert BC Monitor, which measures five target mRNAs (ABL1, CRH, IGF2, UPK1B, ANXA10) using real-time PCR. Descriptive analysis, diagnostic accuracy including sensitivity, specificity, positive (PPV) and negative predictive value (NPV), receiver-operating characteristic curve, and area under the curve (AUC) were calculated. RESULTS The overall sensitivity (0.84) and NPV (0.93) of the Xpert BC Monitor were significantly superior to those of bladder washing cytology (0.33 and 0.76; P < 0.001). Subgroup analyses confirmed the high sensitivity of the Xpert BC Monitor even in low-grade (0.77) and pTa (0.82) disease compared with barbotage cytology (low-grade: 0.13; pTa: 0.21). The overall specificity of the Xpert BC Monitor and barbotage cytology was similar (0.91 vs 0.94; P = 0.41). Combining the Xpert BC Monitor with barbotage cytology (AUC = 0.85) did not enhance diagnostic performance compared with the performance of the Xpert BC Monitor alone (AUC = 0.87). CONCLUSION In this study, we report for the first time that the Xpert BC Monitor, a new mRNA-based urine test, outperforms cytology with regard to sensitivity and NPV, even in low-grade and pTa tumours, with no reduction of specificity.
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Affiliation(s)
- Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Gerald Klinglmair
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Afschin Soleiman
- Clinical Pathology and Cytodiagnostics, Tyrolean State Hospitals Ltd, Innsbruck, Austria
| | | | - Helmut Klocker
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.,Urological Laboratory and Division of Experimental Urology, Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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2
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Spectrophotometric photodynamic detection involving extracorporeal treatment with hexaminolevulinate for bladder cancer cells in voided urine. J Cancer Res Clin Oncol 2017; 143:2309-2316. [PMID: 28726046 DOI: 10.1007/s00432-017-2476-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the feasibility of hexaminolevulinate (HAL) for the photodynamic detection of cancer cells in voided urine. METHODS This study included 50 patients with bladder cancer that was confirmed histologically after transurethral resection (bladder cancer group) and 50 outpatients without a history of urothelial carcinoma or cancer-related findings (no malignancy group). One third of the voided urine samples were incubated with aminolevulinic acid (ALA-treated samples), one third were incubated with HAL (HAL-treated samples), and the remaining samples were incubated without treatment (untreated samples). For detecting cellular protoporphyrin IX levels, the intensity of the samples at the excitation wavelength of 405 nm was measured using a spectrophotometer. The difference between the intensity of the ALA-treated or HAL-treated samples and the untreated samples at 635 nm was calculated. RESULTS HAL-induced fluorescence cytology (HFC) showed that the difference was significantly higher in patients with high-grade tumors than in those with low-grade tumors (p = 0.0003) and the difference was significantly higher in patients with low-grade tumors than in those without a history of urothelial carcinoma or cancer-related findings (p = 0.021). The areas under the receiver operating characteristic curves of ALA-induced fluorescence cytology (AFC) and HFC were 0.77 and 0.81, respectively. The AUC of HFC was significantly higher than that of AFC (p < 0.0001). The overall sensitivity values for conventional cytology, AFC, and HFC were 49, 74, and 74%, respectively. The overall specificity values for AFC and HFC were 70 and 94%, respectively. CONCLUSIONS Spectrophotometric photodynamic detection involving extracorporeal treatment with HAL for bladder cancer cells in voided urine showed high accuracy. This bladder cancer detection method is easy and cost-effective, and has the potential for clinical use.
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Botti G, Malzone MG, La Mantia E, Montanari M, Vanacore D, Rossetti S, Quagliariello V, Cavaliere C, Di Franco R, Castaldo L, Ametrano G, Cappuccio F, Romano FJ, Piscitelli R, Pepe MF, D'Aniello C, Facchini G. ProEx C as Diagnostic Marker for Detection of Urothelial Carcinoma in Urinary Samples: A Review. Int J Med Sci 2017. [PMID: 28638271 PMCID: PMC5479124 DOI: 10.7150/ijms.17890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The gold standard for the detection of urothelial carcinoma is represented by urethro-cystoscopy and biopsy. Both procedures are invasive and expensive and therefore cytology is often used as first approach to investigate on a possible neoplasia, being a safe and cost-effective diagnostic modality of evaluation. Because cytology alone is not highly sensitive for detection of low grade urothelial carcinoma and recurrence of the disease, several adjunct markers and urine based tests for urothelial carcinoma have been developed, which can help in the final diagnosis. In particular, ProEx C is an immunohistochemical cocktail containing antibodies direct against topoisomerase IIα (TOP2A) and minichromosome maintenance 2 (MCM2) proteins. It proved to be a valid biomarker especially in detecting squamous intraepithelial lesions in cervical liquid-based samples and in discerning these lesions from their mimickers, as well as in ovarian, endometrial, vulvar, primary and metastatic melanomas, breast, pancreatic and renal cell carcinomas. This brief review covers the effective utility of ProEx C as adjunct tool in assessing the urothelial lesions in urine cytology, also providing prognostic and therapeutic information to help in clinical decisions.
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Affiliation(s)
- Gerardo Botti
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Maria Gabriella Malzone
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy.,Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Elvira La Mantia
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy.,Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Micaela Montanari
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", 80100 Naples, Italy
| | - Daniela Vanacore
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Sabrina Rossetti
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, Department of Uro-Gynaecological Oncology, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Vincenzo Quagliariello
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, Department of Uro-Gynaecological Oncology, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Carla Cavaliere
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy
| | - Rossella Di Franco
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Radiation Oncology, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Luigi Castaldo
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Urology, Department of Uro-Gynaecological Oncology, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Gianluca Ametrano
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Radiation Oncology, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Francesca Cappuccio
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Psicology Unit, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Francesco Jacopo Romano
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Raffaele Piscitelli
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Pharmacy Unit, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
| | - Maria Filomena Pepe
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy.,Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Carmine D'Aniello
- Progetto ONCONET 2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, A.O.R.N. dei COLLI "Ospedali Monaldi-Cotugno-CTO", Naples, Italy
| | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, National Cancer Institute "Fondazione G. Pascale", 80131 Naples, Italy
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Andreu Z, Otta Oshiro R, Redruello A, López-Martín S, Gutiérrez-Vázquez C, Morato E, Marina AI, Olivier Gómez C, Yáñez-Mó M. Extracellular vesicles as a source for non-invasive biomarkers in bladder cancer progression. Eur J Pharm Sci 2016; 98:70-79. [PMID: 27751843 DOI: 10.1016/j.ejps.2016.10.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 12/18/2022]
Abstract
Bladder cancer is the second most frequent malignancy of the urinary tract after prostate cancer. Current diagnostic techniques, such as cystoscopy and biopsies are highly invasive and accompanied of undesirable side effects. Moreover, there are no suitable biomarkers for relapse or progression prognosis. We analysed whether the specific composition of microRNAs (miRNAs) and proteins of extracellular vesicles (EVs) that urothelial tumour cells of bladder mucosa release into the urine, could reflect their pathologic condition. For this purpose, urinary EVs were isolated and their protein and miRNA composition evaluated in healthy donors and low or high-grade bladder cancer patients. Using a microarray platform containing probes for 851 human miRNAs we found 26 deregulated miRNAs in high-grade bladder cancer urine EVs, from which 23 were downregulated and 3 upregulated. Real-time PCR analysis pointed to miR-375 as a biomarker for high-grade bladder cancer while miR-146a could identify low-grade patients. Finally, several protein markers were also deregulated in EVs from tumour patients. Our data suggest that the presence of ApoB in the 100,000 pellet is a clear marker for malignancy.
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Affiliation(s)
- Zoraida Andreu
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Renan Otta Oshiro
- Servicio de Urología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Spain
| | - Alberto Redruello
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Soraya López-Martín
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Cristina Gutiérrez-Vázquez
- Servicio de Inmunología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Proteómica, CBM-SO, Madrid, Spain; Departamento de Biología Molecular, UAM/CBM-SO, Madrid, Spain
| | | | | | - Carlos Olivier Gómez
- Servicio de Urología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Spain
| | - María Yáñez-Mó
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Departamento de Biología Molecular, UAM/CBM-SO, Madrid, Spain.
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AIB1 predicts bladder cancer outcome and promotes bladder cancer cell proliferation through AKT and E2F1. Br J Cancer 2013; 108:1470-9. [PMID: 23511556 PMCID: PMC3629431 DOI: 10.1038/bjc.2013.81] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: We previously demonstrated that AIB1 overexpression is an independent molecular marker for shortened survival of bladder cancer (BC) patients. In this study, we characterised the role and molecular mechanisms of AIB1 in BC tumorigenicity. Methods: AIB1 expression was measured by immunohistochemistry in non-muscle-invasive BC tissue and adjacent normal bladder tissue. In addition, the tumorigenicity of AIB1 was assessed with in vitro and in vivo functional assays. Results: Overexpression of AIB1 was observed in tissues from 46 out of 146 patients with non-muscle-invasive BC and was an independent predictor for poor progression-free survival. Lentivirus-mediated AIB1 knockdown inhibited cell proliferation both in vitro and in vivo, whereas AIB1 overexpression promoted cell proliferation in vitro. The growth-inhibitory effect induced by AIB1 knockdown was mediated by G1 arrest, which was caused by reduced expression of key cell-cycle regulatory proteins through the AKT pathway and E2F1. Conclusion: Our results suggest that AIB1 promotes BC cell proliferation through the AKT pathway and E2F1. Furthermore, AIB1 overexpression predicts tumour progression in patients with non-muscle-invasive BC.
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7
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Larré S, Catto JWF, Cookson MS, Messing EM, Shariat SF, Soloway MS, Svatek RS, Lotan Y, Zlotta AR, Grossman HB. Screening for bladder cancer: rationale, limitations, whom to target, and perspectives. Eur Urol 2013; 63:1049-58. [PMID: 23313034 DOI: 10.1016/j.eururo.2012.12.062] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/31/2012] [Indexed: 11/24/2022]
Abstract
CONTEXT Bladder cancer (BCa) is the fourth most common cancer in men. Survival from the disease has not improved in the last 25 yr. Population-based screening theoretically provides the best opportunity to improve the outcomes of aggressive BCa. OBJECTIVE To review the current literature regarding the usefulness and feasibility of screening for bladder cancer. EVIDENCE ACQUISITION We conducted a nonsystematic review restricted to English using the keywords urinary bladder neoplasms, mass screening, mandatory testing, and early detection of cancer. We retrieved 184 articles and selected 22. EVIDENCE SYNTHESIS There was no level 1 evidence (obtained from a randomised controlled trial [RCT]) addressing the impact of screening on BCa survival or tumour downstaging. No study assessed the diagnostic performance of urinary markers in the context of screening. Two case-control series suggested a benefit of screening on survival, and a third found a nonsignificant beneficial trend in favour of screening. Two studies suggested downstaging of BCa at diagnosis. Other reports concluded that most cancers detected with screening were of low grade and that current urinary testing cannot detect all tumours. Screening is likely to be of benefit in high-risk populations using cost-efficient high-performing urinary biomarkers. There was insufficient evidence to define an efficient screening protocol. CONCLUSIONS Although BCa screening is theoretically feasible in a high-risk population, there is currently insufficient evidence to recommend it. This is due to insufficient data to define an efficient screening protocol with selection of an appropriate population and the lack of accurate and cost-effective urinary markers able to discriminate low-risk from high-risk cancers. Major improvements are needed in the evaluation of urinary biomarkers before evaluation in a RCT can be achieved.
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Affiliation(s)
- Stéphane Larré
- Robert Debré Teaching Hospital, Department of Urology, University of Reims, Reims, France.
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8
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Li F, Chen DN, He CW, Zhou Y, Olkkonen VM, He N, Chen W, Wan P, Chen SS, Zhu YT, Lan KJ, Tan WL. Identification of urinary Gc-globulin as a novel biomarker for bladder cancer by two-dimensional fluorescent differential gel electrophoresis (2D-DIGE). J Proteomics 2012; 77:225-36. [PMID: 22986152 DOI: 10.1016/j.jprot.2012.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 12/29/2022]
Abstract
Improving the early detection rate and surveillance of bladder cancer remains a great challenge in medicine. Here, we identified sixteen proteins including Gc-globulin (GC) in urine from bladder cancer patients and normal controls by two-dimensional fluorescent differential gel electrophoresis (2D-DIGE) and matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF/TOF MS). Bioinformatics analyses indicated GC played important roles in the regulation of growth, apoptosis, death and epidermal growth factor receptor activity. The GC expression patterns in urine or tissue from cases and controls were further quantified by western blotting, immunohistochemical staining and enzyme-linked immunosorbent assay (ELISA). ELISA quantification by correcting for creatinine expression showed GC-Cr was significantly increased in bladder cancer patients than in benign bladder damages cases and normal controls (1013.70±851.25 versus 99.34±55.87, 105.32±47.81 ng/mg, respectively). Receiver operating characteristic (ROC) analysis suggested that at 161.086 ng/mg urinary GC, bladder cancer could be detected with 92.31% sensitivity and 83.02% specificity, and 1407.481 ng/mg with 82.61% sensitivity and 88.24% specificity could be used for the detection of infiltrating urothelial carcinoma of bladder cancer. Taken together, we identified GC as a potential novel urinary biomarker for the early detection and surveillance of bladder cancer.
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Affiliation(s)
- Fei Li
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
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9
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Lotan Y. The impact of biomarkers in multivariate algorithms for bladder cancer diagnosis in patients with hematuria. Cancer 2012; 118:2566-7. [DOI: 10.1002/cncr.26535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 08/01/2011] [Accepted: 08/01/2011] [Indexed: 11/08/2022]
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10
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Abstract
Introduction: A total of 356,557 new cases were diagnosed annually worldwide in 2009, it was estimated that 52,810 new patients were to be diagnosed with bladder cancer and there were 10,180 projected deaths from the disease in the USA. Despite being the fourth commonest cancer in men, we do not have an early detection/screening program for bladder cancer. The review was aimed at looking at the evidence for the rationale for an early detection program for bladder cancer. Materials and Methods: A detailed search on bladder cancer epidemiology, diagnosis, pathology, tumor markers, treatment outcomes, screening, morbidity and mortality of bladder cancer was carried out on Pubmed central/Medline. Original articles, review articles, monograms, book chapters on bladder cancer, text books on urological oncology, oncology and urology were reviewed. The latest information for new articles before publication was last accessed in June 2010. Discussion and Conclusions: Bladder cancer is the fourth commonest cancer in men, the annual death rate from this disease is significant and every year there is an increase in its incidence globally. The prognosis of bladder cancer is stage and grade dependent; the lower the stage (T2 or less) the better is the survival. Delay in the diagnosis and treatment does alter the overall outcome. Therefore, there is a clear need for early detection of bladder cancer and screening program. Although we do not have an ideal marker for bladder cancer, it is time we maximize the potential of markers such as UroVysion, NMP22 along with cytology to start such a program. May be as a first step the early detection and screening program could be started in high-risk population. It is not worth waiting till we find the best marker as it would be unfair to our patients. The fear of unnecessary tests and treatment in bladder cancer after its detection in screening program is without any substance. The cost-effectiveness of such a program is certainly comparable to that is used for colon or breast and for prostate as well.
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Affiliation(s)
- Makarand V Khochikar
- Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India
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Aharony S, Baniel J, Yossepowitch O. Clinically unconfirmed positive urinary cytology: diagnostic implications and oncological outcomes. BJU Int 2011; 108:E179-83. [DOI: 10.1111/j.1464-410x.2011.10210.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Lotan Y, Shariat SF, Schmitz-Dräger BJ, Sanchez-Carbayo M, Jankevicius F, Racioppi M, Minner SJP, Stöhr B, Bassi PF, Grossman HB. Considerations on implementing diagnostic markers into clinical decision making in bladder cancer. Urol Oncol 2010; 28:441-8. [PMID: 20610281 DOI: 10.1016/j.urolonc.2009.11.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/27/2009] [Accepted: 11/04/2009] [Indexed: 01/11/2023]
Abstract
Bladder cancer is a common disease that is often detected late and has a high rate of recurrence and progression. Cystoscopy is the main tool in detection and surveillance of bladder cancer but is invasive and can miss some cancers. Cytology is frequently utilized but suffers from a poor sensitivity. There are several commercially available urine-based tumor markers currently available but their use is not recommended by guideline panels. Markers such as the Urovysion FISH assay and the NMP22 BladderChek test are approved for surveillance and detection in patients with hematuria. The added benefit of these markers and other commercially available markers (e.g. Ucyt+, BTA stat) has not been well investigated though it appears these markers are insufficiently sensitive to replace cystoscopy. Additional studies are needed to determine the clinical scenarios where bladder markers are best utilized (screening, surveillance, early detection, evaluating cytologic atypia) and what impact they should have on clinical decision making. Furthermore, a variety of issues and barriers can affect the movement of clinical tests from research to clinical practice. This article addresses some of the challenges facing research and medical communities in the delivery and integration of markers for bladder cancer diagnosis. Moreover, we attempt to outline criteria for the clinical utility of new bladder cancer diagnostic markers.
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Affiliation(s)
- Yair Lotan
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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15
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Stone R, Sabichi AL, Gill J, Lee IL, Adegboyega P, Dai MS, Loganantharaj R, Trutschl M, Cvek U, Clifford JL. Identification of genes correlated with early-stage bladder cancer progression. Cancer Prev Res (Phila) 2010; 3:776-86. [PMID: 20501863 PMCID: PMC2881179 DOI: 10.1158/1940-6207.capr-09-0189] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transitional cell carcinoma (TCC) of the bladder ranks fourth in incidence of all cancers in the developed world, yet the mechanisms of its origin and progression remain poorly understood. There are also few useful diagnostic or prognostic biomarkers for this disease. We have combined a transgenic mouse model for invasive bladder cancer (UPII-SV40Tag mice) with DNA microarray technology to determine molecular mechanisms involved in early TCC development and to identify new biomarkers for detection, diagnosis, and prognosis of TCC. We have identified genes that are differentially expressed between the bladders of UPII-SV40Tag mice and their age-matched wild-type littermates at 3, 6, 20, and 30 weeks of age. These are ages that correspond to premalignant, carcinoma in situ, and early-stage and later stage invasive TCC, respectively. Our preliminary analysis of the microarray data sets has revealed approximately 1,900 unique genes differentially expressed (> or =3-fold difference at one or more time points) between wild-type and UPII-SV40Tag urothelium during the time course of tumor development. Among these, there were a high proportion of cell cycle regulatory genes and a proliferation signaling genes that are more strongly expressed in the UPII-SV40Tag bladder urothelium. We show that several of the genes upregulated in UPII-SV40Tag urothelium, including RacGAP1, PCNA, and Hmmr, are expressed at high levels in superficial bladder TCC patient samples. These findings provide insight into the earliest events in the development of bladder TCC as well as identify several promising early-stage biomarkers.
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MESH Headings
- Animals
- Carcinoma in Situ/genetics
- Carcinoma in Situ/metabolism
- Carcinoma in Situ/pathology
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Cell Cycle Proteins/biosynthesis
- Cell Cycle Proteins/genetics
- Disease Models, Animal
- Disease Progression
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Gene Regulatory Networks
- Genes, Neoplasm
- Humans
- Hyperplasia
- Magnetic Resonance Imaging
- Mice
- Mice, Transgenic
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Oligonucleotide Array Sequence Analysis
- Precancerous Conditions/genetics
- Precancerous Conditions/metabolism
- Precancerous Conditions/pathology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Neoplasm/biosynthesis
- RNA, Neoplasm/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Urinary Bladder Diseases/genetics
- Urinary Bladder Diseases/metabolism
- Urinary Bladder Diseases/pathology
- Urinary Bladder Neoplasms/genetics
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
- Urothelium/metabolism
- Urothelium/pathology
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Affiliation(s)
- Randolph Stone
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center-Shreveport and Feist-Weiller Cancer Center
| | - Anita L. Sabichi
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas, MD Anderson Cancer Center
| | - Jennifer Gill
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center-Shreveport and Feist-Weiller Cancer Center
| | - I-ling Lee
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas, MD Anderson Cancer Center
| | - Patrick Adegboyega
- Department of Pathology, Louisiana State University Health Sciences Center-Shreveport and Feist-Weiller Cancer Center
| | - Michael S. Dai
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center-Shreveport and Feist-Weiller Cancer Center
| | | | - Marjan Trutschl
- Department of Computer Science, Louisiana State University-Shreveport
| | - Urska Cvek
- Department of Computer Science, Louisiana State University-Shreveport
| | - John L. Clifford
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center-Shreveport and Feist-Weiller Cancer Center
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Robinson VL, Porter M, Messing E, Fradet Y, Kamat AM, Lotan Y. BCAN Think Tank session 2: Molecular detection of bladder cancer: The path to progress. Urol Oncol 2010; 28:334-7. [DOI: 10.1016/j.urolonc.2009.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 07/23/2009] [Indexed: 12/18/2022]
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Tsui KH, Tang P, Lin CY, Chang PL, Chang CH, Yung BYM. Bikunin loss in urine as useful marker for bladder carcinoma. J Urol 2010; 183:339-44. [PMID: 19914646 DOI: 10.1016/j.juro.2009.08.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We searched for bladder tumor markers by analyzing urine samples from patients with bladder cancer and normal individuals. MATERIALS AND METHODS Proteins in urine samples of patients with cancer and normal subjects were systematically examined by 2-dimensional electrophoresis combined with matrix assisted laser desorption ionization time-of-flight mass spectrometry. Of the proteins bikunin expression was confirmed by Western blot analysis and further evaluated. To correlate urinary bikunin levels with clinical significance we examined urine samples from patients with bladder cancer and normal controls for bikunin expression in parallel with pro-urolinase-plasminogen activator, which was previously shown to be associated with advanced bladder carcinoma. RESULTS A significant relationship was established between the low level and absence of bikunin, and pro-urolinase-plasminogen activator in urine samples from patients with bladder tumors. CONCLUSIONS Analysis of urinary proteomes may be a feasible, noninvasive and efficient strategy for searching for potential bladder tumor biomarkers. We identified bikunin loss in urine as a potential bladder carcinoma marker.
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Affiliation(s)
- Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital, Chang Gung Bioinformatics Center, Taiwan, Republic of China
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