Diagnostic, prognostic and surveillance urinary markers in nonmuscle invasive bladder cancer: any role in clinical practice?

Overview

PURPOSE OF REVIEW: To summarize the current knowledge about the clinical role of novel urinary markers in bladder cancer (BCa) management, from diagnosis to follow-up, from prognosis of oncological outcomes to response to intravesical therapy. RECENT FINDINGS: Urinary markers have been developed to overcome the limitations of the current available tools for the diagnosis and surveillance of BCa patients. However, to date, because of their limited performances, urinary markers are not generally used in clinical practice. For a marker to be of clinical benefit, it needs to be better, easier, faster and cheaper. The differential requirements for a marker's diagnostic performances depend on goals for clinical utility. Their most promising role seems to be in settings such as in case of equivocal cystoscopy/cytology during follow-up of nonmuscle invasive tumors. Newer markers are available or in development using panels of markers of RNA expression or methylation. SUMMARY: To date, there are multiple urine markers that have improved sensitivity over cytology but there is lack of validation of clinical utility. Some of the recently developed markers aim to change the paradigm of BCa follow-up by replacing or reducing the need of invasive investigations. Further prospective validations are needed to confirm these findings.