Old and new urinary markers: Which one is the PSA for bladder cancer?

Objectives: To review the role of urinary-based markers in the management of bladder cancer. Methods: A literature search was performed to examine the field of urinary-based markers for bladder cancer. The principles for an ideal test to detect bladder cancer using a urinary assay were defined. Reported biomarkers were evaluated for their potential to fulfil these principles. Results: Many of the criteria defined by Wilson and Junger for a screening program can be applied to urinary-based bladder cancer markers. Biomarkers can be used to either diagnose the disease or survey patients to detect progression or recurrence following initial endoscopic surgery. These roles are separate and different biomarkers may be needed to reflect the biology of these processes. To date, NMP22 appears as one of the best evaluated biomarkers, but its role needs to be clearly defined. Most biomarkers detect one form of bladder cancer, either invasive or noninvasive, and thus have a lower sensitivity than needed to replace cystoscopy. Conclusions: Many reported urinary-based biomarkers can be used within appropriate management regimens to reduce cystoscopic burden and produce economic savings. No biomarker reported to date is sufficiently accurate to replace the need for cystoscopy. (c) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.