Text Box: urologists together recently to form a consensus on screening for bladder cancer. Urologists seem to define the term “bladder cancer” as a synonym for “urothelial neoplasm”. When they speak of screening, they refer to high-risk people, not the general population. This includes any person over 40 years old with a history of cigarette smoking as well as any patient who has already developed a bladder cancer. Tumor markers include an ever-increasing array of substances that are associated with the presence rather than the future development of a urothelial neoplasm. One gets the impression that urologists as a group are not keen on screening non-bladder cancer patients and haven’t come to grips with the issues. Among available markers, the only one that seems to be favorably viewed by the majority is hematuria evaluated by dipstick. The data are mixed but Text Box: Immunocyt and FISH do not destroy the cells during the assay. Immunocyt is based on immunofluorescence but seems to be very difficult to use. Its promoters talked about a “learning curve”. The Vysis FISH assay is somewhat easier to evaluate in skilled hands (cytotechnologists are used at the Mayo Clinic) but it’s expensive. It may well be more sensitive than urinary cytology only because of an enhanced ability for any observer to see colored dots on a black background rather than abnormal cells in a mixed cellular background. There seemed to be slightly more enthusiasm for tumor markers in the follow-up of patients with known bladder tumors, where their use could decrease the frequency of cystoscopy. Most urologists would probably confine such tests to individuals with high-grade lesions or recurrent low-grade, papillary tumors, however. Most urologists realize that patients presenting with high-grade neoplasms, whether invasive or not, are at greatly increased risk of death from disease. The Text Box: Bladder Cancer Screening

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Florida Pathology

by Dr. William Murphy
Text Box: indicate that patients with dipstick positive tests have a higher frequency of bladder cancer than those with negative findings. The yield is predictably low (less than 1%) and only 3-11% of those with a positive test have had bladder tumors, even in the prevalence population. Dipstick tests are cheap and easy; it’s what comes next that’s at issue. In fact, there was no agreement about what should come next. All of the options—cystoscopy, urinary cytology, tumor markers—are suboptimal for screening. Some markers, e.g., BTA, measure substances that will occur in most patients having hematuria and therefore will not further subclassify that population. Others are extraordinarily sensitive but not FDA approved, associated with unacceptable levels of false positive and negative results, or both. Only a few markers, e.g., Immunocyt, telomerase, microsatellite chromosomal aberrations and the chromosome-based FISH assay– actually claim to identify tumor cells versus some product of the neoplastic process and only

The International Society of Urology brought many of the world’s leading

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