Epidemiology, diagnosis and urine-based investigation techniques in bladder cancer

In Germany, carcinoma of the urinary bladder has the fourth highest incidence of any tumor entity for men and the fifth highest for women. Urothelial carcinomas can develop at any point in the entire urinary tract. In the vast majority of cases they are bladder carcinomas. The diagnosis of a bladder carcinoma is made by means of a transurethral resection, which is also the first step in treatment. Cytoscopy is performed to monitor the surgery. Urine-based examination procedures do not allow a diagnosis, but can reinforce the suspicion of bladder carcinoma. Examples of established urine-based investigation procedures are testing for microhaematuria and urinary cytology. The latter is basically an aid to the diagnosis of urothelial neoplasms. Tumor markers are diagnostic tools that should not be applied unless their levels would have implications for diagnosis or treatment and the patient would benefit from their use. Numerous urinary markers are introduced in this paper, but none of them has so far become firmly established in diagnosis or follow-up monitoring of carcinoma of the urinary bladder, since they all give a relatively high rate of false-positive results as a result of their low specificity, even though some have high sensitivity. It does not therefore seem sensible to replace cytoscopy by the use of markers in follow-up before further studies have been carried out.