Non-Invasive Urine Tests Show Promise in Bladder Cancer Detection, Monitoring

With no available diagnostic tests for the detection and/or monitoring of bladder cancer, researchers from the Medical College of Georgia at Augusta University may have two new urine tests that determine the disease’s severity and detect for its recurrence.

The researchers are evaluating a test that looks at levels of V1 — a gene variant that is higher in bladder cancer as it is more vulnerable to the disease.

With support from the National Cancer Institute and the U.S. Department of Defense, they have set out to compare the new urine tests with traditional methods, including frequent cystoscopies — an invasive procedure where a small camera is inserted through the urethra and into the bladder – or urine cytology – which does not always detect for the disease accurately.

“If a patient has hematuria (blood in their urine) 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,” explained Dr. Vinata Lokeshwar, chair of the Department of Biochemistry and Molecular Biology at the Medical College of Georgia at Augusta University.

“The tumors that invade into the bladder wall have a higher chance of being metastatic and those are the patients 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.”

In preliminary findings, the researchers have found that the V1 activity measured with their test — an “enzyme activity assay” – induced more than 90% sensitivity and specificity in detecting bladder cancer.

Moreover, the test was more sensitive for detecting high grade bladder cancer, “which are the patients we want to detect early because this is the cancer that invades the muscle,” Lokeshwar said.

“For this reason, the impetus is to find non-invasive urine tests. There is not really any risk for the patient,” said Lokeshwar. “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.”

Lokeshwar noted that the test could not only improve outcomes, but also reduce costs for this “high-maintenance disease,” that requires a high volume of surveillance within the first two years of remission and on.

“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,” she said.

“That is why bladder cancer is considered one of the most expensive cancers to treat or clinically manage from diagnosis to the final outcome,” Lokeshwar added. “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.”