Researchers Address Unmet Need in Bladder Cancer Detection

Two new urine tests currently being investigated for bladder cancer detection and monitoring have demonstrated more than 90% sensitivity and specificity — highlighting the potential for addressing an unmet need among this patient population.

In a recent interview with Oncology Nursing News, study investigator Vinata Lokeshwar, PhD, chair of the Department of Biochemistry and Molecular Biology at the Medical College of Georgia at Augusta University, discussed the need for non-invasive testing in bladder cancer and why these tests show promise.

What are the signs and symptoms patients should be aware of in bladder cancer?

Lokeshwar: The patients present with blood in their urine, which is called hematuria. When patients go to the doctor, they do something called cystoscopy where there is a long tube inserted into the urethra and the camera and the urologists look into the bladder for a tumor. It is an invasive tumor, expensive and is not without side effects. This is not something that is done routinely unless a patient presents with hematuria.

If a patient has hematuria and has bladder cancer, 30% of those tumors are high grade in the sense that those are the ones that can lead to later tumors invading into the bladder wall, which is invasive. The tumors that invade into the bladder wall, they have more chance of being metastatic and those are the ones where there is poor clinical outcome.

So, the idea is if you can catch a tumor early, then it will be a good thing for the patients, especially if a patient has hematuria then you can catch the tumor.

What is the unmet need when it comes to tests for detection and monitoring of bladder cancer?

At the same time, not every hematuria patient has bladder cancer. Sometimes this hematuria is not even visible or symptomatic. In those patients, to detect hematuria and have to undergo cystoscopy, that is unnecessary when there is no bladder tumor because only about 15% to 25% of patients who can visibly see blood in their urine have bladder cancer and less than 10% of patients with asymptomatic hematuria have bladder cancer. So, you can imagine then we are doing so many cystoscopies for patients who don’t need them. As a result, it is a lot of cost to our health care system as well as we are putting patients through an invasive procedure.

For this reason, the impetus is to find non-invasive urine tests. There is not really any risk for the patient. We need a highly accurate, non-invasive test that can detect bladder cancer in patients with hematuria because that way you are going to avoid patients unnecessarily going through cystoscopy, but at the same time you may stop the delay in getting cystoscopy for patients who really need it.

What are the benefits of a urine test versus others?

Bladder tumors have a high frequency of recurrence — 50% to 80% of patients who have had one bladder tumor that has been removed have a chance they will develop another tumor in the bladder within two years. So, once they’ve had a new tumor, you are on the same cycle. That is why bladder cancer is considered one of the most expensive cancers to treat or clinically manage from diagnosis to the final outcome. It is a high-maintenance disease because you also have to consider this. If patients have to undergo cystoscopy on a routine basis at certain intervals, it would be nice to have a urine test that can monitor the cancer as good as a cystoscopy. This way we can reduce the number of cystoscopies that are done on a patient.