Can urinary biomarkers replace cystoscopic examination in bladder cancer surveillance?

Bladder cancer: therapeutic challenges and role of 3D cell culture systems in the screening of novel cancer therapeutics

Bladder cancer (BC) is the sixth most common worldwide urologic malignancy associated with elevated morbidity and mortality rates if not well treated. The muscle-invasive form of BC develops in about 25% of patients. Moreover, according to estimates, 50% of patients with invasive BC experience fatal metastatic relapses. Currently, resistance to drug-based therapy is the major tumble to BC treatment. The three-dimensional (3D) cell cultures are clearly more relevant not only as a novel evolving gadget in drug screening but also as a bearable therapeutic for different diseases. In this review, various subtypes of BC and mechanisms of drug resistance to the commonly used anticancer therapies are discussed. We also summarize the key lineaments of the latest cell-based assays utilizing 3D cell culture systems and their impact on understanding the pathophysiology of BC. Such knowledge could ultimately help to address the most efficient BC treatment.

Advances in point-of-care diagnostic devices in cancers

The early diagnosis and monitoring of the progress of cancers are limited due to the lack of adequate screening tools.

Immunosensor for the ultrasensitive and quantitative detection of bladder cancer in point of care testing

An ultrasensitive and real-time impedance based immunosensor has been fabricated for the quantitative detection of Galectin-1 (Gal-1) protein, a biomarker for the onset of multiple oncological conditions, especially bladder cancer. The chip consists of a gold annular interdigitated microelectrode array (3×3 format with a sensing area of 200µm) patterned using standard microfabrication processes, with the ability to electrically address each electrode individually. To improve sensitivity and immobilization efficiency, we have utilized nanoprobes (Gal-1 antibodies conjugated to alumina nanoparticles through silane modification) that are trapped on the microelectrode surface using programmable dielectrophoretic manipulations. The limit of detection of the immunosensor for Gal-1 protein is 0.0078mg/ml of T24 (Grade III) cell lysate in phosphate buffered saline, artificial urine and human urine samples. The normalized impedance variations show a linear dependence on the concentration of cell lysate present while specificity is demonstrated by comparing the immunosensor response for two different grades of bladder cancer cell lysates. We have also designed a portable impedance analyzing device to connect the immunosensor for regular checkup in point of care testing with the ability to transfer data over the internet using a personal computer. We believe that this diagnostic system would allow for improved public health monitoring and aid in early cancer diagnosis.

Urine biomarkers of schistosomiais and its associated bladder cancer

Schistosomiasis (SCH) is the second only to malaria among the parasitic diseases affecting humans regarding the prevalence of infection worldwide. In this nonsystematic review, we summarize the existing data on commercially available and promising investigational urine markers for the detection of SCH and its associated bladder cancer (BC). We searched PubMed, Scopus and Cochran without time limits. We reviewed the recent literatures on urine-based markers for SCH and its associated BC. Many studies identified several urine biomarkers of Schistosoma haematobium and Schistosoma mansoni worms and their associated BC using automated, inexpensive, quantitative assays in urine. These markers may aid in early detection of bladder carcinoma and have the potential to reduce the number of follow-up cystoscopy, thus reducing healthcare costs and patient discomfort, at the same time. Nevertheless, clinical evidence is insufficient to warrant the substitution of the cystoscopic follow-up scheme by any of the currently available urine marker tests.

Development of novel imaging probe for optical/acoustic radiation imaging (OARI)

PURPOSE

Optical/acoustic radiation imaging (OARI) is a novel imaging modality being developed to interrogate the optical and mechanical properties of soft tissues. OARI uses acoustic radiation force to generate displacement in soft tissue. Optical images before and after the application of the force are used to generate displacement maps that provide information about the mechanical properties of the tissue under interrogation. Since the images are optical images, they also represent the optical properties of the tissue as well. In this paper, the authors present the first imaging probe that uses acoustic radiation force in conjunction with optical coherence tomography (OCT) to provide information about the optical and mechanical properties of tissues to assist in the diagnosis and staging of epithelial cancers, and in particular bladder cancer.

METHODS

The OARI prototype probe consisted of an OCT probe encased in a plastic sheath, a miniaturized transducer glued to a plastic holder, both of which were encased in a 10 cm stainless steel tube with an inner diameter of 10 mm. The transducer delivered an acoustic intensity of 18 W/cm(2) and the OCT probe had a spatial resolution of approximately 10-20 μm. The tube was filled with deionized water for acoustic coupling and covered by a low density polyethylene cap. The OARI probe was characterized and tested on bladder wall phantoms. The phantoms possessed Young's moduli ranging from 10.2 to 12 kPa, mass density of 1.05 g/cm(3), acoustic attenuation coefficient of 0.66 dB/cm MHz, speed of sound of 1591 m/s, and optical scattering coefficient of 1.80 mm(-1). Finite element model (FEM) theoretical simulations were performed to assess the performance of the OARI probe.

RESULTS

The authors obtained displacements of 9.4, 8.7, and 3.4 μm for the 3%, 4%, and 5% bladder wall phantoms, respectively. This shows that the probe is capable of generating optical images, and also has the ability to generate and track displacements in tissue. This will provide information about the optical and mechanical properties of the tissue to assist in epithelial cancer detection. The corresponding theoretical FEM displacement was 5.8, 5.4, and 5.0 μm for the 3%, 4%, and 5% phantoms, respectively. Deviation between OARI displacement and FEM displacement is due to the resolution of the crosscorrelation algorithm used to track the displacement. To the authors' knowledge, this is the first probe that successfully combines OCT with a source of acoustic radiation force.

CONCLUSIONS

The OARI probe has the ability to provide information about the mechanical and optical properties of phantoms and soft tissue. This could prove useful in early epithelial cancer detection. Because the probe is 10 mm in diameter, it is currently only useful for skin and oral applications. The probe would have to be reduced in size to make it applicable for cancer detection in other internal sites. Future work will focus on utilizing phase-sensitive optical coherence elastography to obtain the resulting OARI displacements, improving the resolution of the probe, and enable physicians to better evaluate the mechanical properties of soft tissues.

Recent advances in the diagnosis and treatment of bladder cancer

Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.

Diagnosis of bladder cancer by immunocytochemical detection of minichromosome maintenance protein-2 in cells retrieved from urine

Background:

We tested the accuracy of immunocytochemistry (ICC) for minichromosome maintenance protein-2 (MCM-2) in diagnosing bladder cancer, using cells retrieved from urine.

Methods:

Adequate samples were obtained from 497 patients, the majority presenting with gross haematuria (GH) or undergoing cystoscopic surveillance (CS) following previous bladder cancer. We performed an initial study of 313 patients, followed by a validation study of 184 patients. In all cases, presence/absence of bladder cancer was established by cystoscopy/biopsy.

Results:

In the initial study, receiver operator characteristic analysis showed an area under the curve of 0.820 (P<0.0005) for the GH group and 0.821 (P<0.01) for the CS group. Optimal sensitivity/specificity were provided by threshold values of 50+ MCM-2-positive cells in GH samples and 200+ cells in CS samples, based on a minimum total cell number of 5000. Applying these thresholds to the validation data set gave 81.3% sensitivity, 76.0% specificity and 92.7% negative predictive value (NPV) in GH and 63.2% sensitivity, 89.9% specificity and 89.9% NPV in CS. Minichromosome maintenance protein-2 ICC provided clinically relevant improvements over urine cytology, with greater sensitivity in GH and greater specificity in CS (P=0.05).

Conclusions:

Minichromosome maintenance protein-2 ICC is a reproducible and accurate test that is suitable for both GH and CS patient groups.