Performance characteristics of multiple urinary tumor markers and sample collection techniques in the detection of transitional cell carcinoma of the bladder

Background: The optimal management of bladder cancer requires early detection of both primary tumor as well as recurrences. This study compared the methodologies of the following tumor markers and diagnostic tools: telomerase, bladder tumor-associated analytes (BTA stat), nuclear matrix protein 22 (NMP22), the hemoglobin (Hb) dipstick and chemiluminometric red cell assays, and determined their respective sensitivity and specificity in detection of bladder cancer along with urine cytology. Methods: Different sample collection techniques were used including bladder tissue from radical cystectomy or transurethral resection, voided and cystoscopically collected urine and bladder washes. Results of these techniques were compared for some of these markers. Results: The first study utilizing cystoscopically collected urine and bladder washes, the sensitivity of telomerase in detecting bladder cancer was 92% and 87%, respectively, whereas for bladder tissue it was 93%. The sensitivities of cytology, NMP22 and original BTA, however, were 62%, 54% and 49%, respectively. In the second study using first single voided urine from patients with bladder cancer and non-bladder cancer controls, the greatest sensitivity (overall 77%) and specificity (overall 98%) was exhibited with telomerase. The combined sensitivity of telomerase with that of either the hemoglobin dipstick or chemiluminometric red cell assays, showed that the overall sensitivity was increased to 89% and specificity to 98%. Conclusions: The sensitivity and specificity of telomerase activity in conjunction with chemiluminometric red cell or hemoglobin dipstick assay may be considered as an alternative to urinary cytology. It can also supplement cystoscopy for monitoring recurrence of bladder cancer.