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A family of tests on a urine sample that look for cancer cells or their DNA and RNA; none can yet replace a camera examination of the bladder, but the newer ones are good enough to let low-risk patients safely skip some of them.
What they measure. Bladder tumours shed cells and nucleic acids straight into urine, so urine is the natural sample. The oldest test is cytology, a pathologist looking for malignant cells, which is very specific for high-grade cancer but misses most low-grade tumours. Protein tests (NMP22, BTA) are cheap but give false positives with infection, stones and haematuria. UroVysion uses fluorescence in situ hybridisation to spot the chromosome gains and 9p21 loss typical of bladder cancer. Cxbladder measures five messenger RNAs; Xpert Bladder Cancer measures five others on a cartridge; Bladder EpiCheck reads a panel of methylation markers; and research tests sequence urine DNA for the FGFR3, TERT promoter and other mutations found in most tumours.
Who should have them. Two settings. In the work-up of blood in the urine, a very sensitive test with a high negative predictive value can let a patient with low risk avoid cystoscopy. In follow-up of treated non-muscle-invasive bladder cancer, where patients face cystoscopy every three to twelve months for years, a negative urine test can lengthen the interval or replace alternate examinations. European Association of Urology guidelines currently allow urine tests to complement cystoscopy and cytology but not to replace them, and the FDA-approved tests (UroVysion, NMP22, BTA) are for monitoring known cancer and for haematuria work-up alongside cystoscopy.
What changes. A positive test prompts cystoscopy, upper tract imaging and, if nothing is seen, a closer look with blue-light cystoscopy or repeat testing. A negative high-sensitivity test in a low-risk patient can defer cystoscopy, which is the cost and comfort argument. Costs range from a few pounds for cytology to a few hundred for RNA or methylation tests; cytology and UroVysion are widely available, the newer tests through their makers' laboratories. Randomised trials of replacing surveillance cystoscopy with urine testing are in progress.
Detect exfoliated tumour cells (cytology), chromosomal aberrations (FISH), tumour-associated proteins, messenger RNA panels or DNA methylation and mutations in voided urine, reported against thresholds tuned for haematuria triage or surveillance.
Query for this technology: (TITLE:"Urine tests for bladder cancer" OR ABSTRACT:"Urine tests for bladder cancer" OR TITLE:"cytology, FISH, RNA and methylation" OR ABSTRACT:"cytology, FISH, RNA and methylation" OR TITLE:"urinary biomarkers" OR ABSTRACT:"urinary biomarkers" OR TITLE:"urine cytology" OR ABSTRACT:"urine cytology") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Urine tests for bladder cancer (cytology, FISH, RNA and methylation), not a curated reading list.
Shares Abbott Laboratories, Sensitivity and specificity, DNA methylation profiling.
Shares Bladder EpiCheck urine methylation test, Non-muscle-invasive bladder cancer.
Shares Cystoscopy, blue-light imaging & TURBT, Bladder & urothelial cancer.
Shares Non-muscle-invasive bladder cancer, Muscle-invasive and advanced bladder cancer, Bladder & urothelial cancer.
Shares Sensitivity and specificity, Positive predictive value (PPV), DNA methylation profiling, Bladder & urothelial cancer.
Shares Sensitivity and specificity, DNA methylation profiling.
Shares Cytogenetics and FISH, DNA methylation profiling, RNA sequencing & expression profiling.
Shares Positive predictive value (PPV), DNA methylation profiling.