Urine Test Decreases Cystoscopies in Patients With Bladder Cancer

A urine-based test may decrease the number of invasive cystoscopies in patients with non-muscle-invasive bladder cancer.

A cystoscopy is a procedure that involves the insertion of a probe through the urethra and into the bladder. Doctors commonly use them to check for signs of cancer in patients with the disease. While they are typically safe, they can cause patient discomfort and carry a risk of infection. However, continued follow-up is needed for this patient population, as, according to research published in JAMA Network, the recurrence rate is between 50% and 70%.

MORE: Differentiating Muscle-Invasive, Non-Muscle-Invasive Bladder Cancer

A new tool called the Xpert Bladder Cancer Monitor tests for genetic markers that could tip doctors off to a cancer recurrence. In a trial conducted in Denmark, cystoscopy rates across two years for patients with non-muscle-invasive bladder cancer fell from 100% to 44% with the use of the new urine test.

CURE® spoke with study author, Dr. Thomas Dreyer, researcher at the Bladder Cancer Research Team, Dept of Urology, Aarhus University Hospital in Denmark, about these findings.

Can you explain your research, and why it was important to find a viable alternative to cystoscopies?

Our research is the first randomized clinical trial that investigates the use of the urinary biomarker test Xpert Bladder Cancer Monitor instead of cystoscopy in the follow-up of high-grade non-muscle-invasive bladder cancer.

Due to frequent recurrences of non-muscle-invasive bladder cancer and the risk of progression to muscle-invasive bladder cancer, especially for high-grade disease, frequent cystoscopy is warranted. Clinical guidelines in European countries and America vary between every three to four months the first two years after diagnosis (both for primary and recurrent disease). Thus, cystoscopy is a frequent invasive procedure that for many patients is anxiety-inducing, painful and can lead to urinary tract infections.

The use of a non-invasive test can thus reduce these side effects associated with cystoscopy to the benefit of the patients. Our research has found that reducing the number of cystoscopies during the first two years after high-grade non-muscle-invasive bladder cancer is possible.

Which patients may be best suited for a urine test, and which ones should still undergo a cystoscope?

Multiple studies have shown that the Xpert Bladder Cancer Monitor has the highest diagnostic performance for high-grade non-muscle-invasive bladder cancer. These patients are also under more frequent follow-up than [for example] low-grade patients, and thus more cystoscopies "are there" to be replaced.

It's important of course to note that patients with a positive Xpert Bladder Cancer Monitor, indicating disease recurrence, should undergo cystoscopy, as visible detection and characterization is important for further treatment.

What do patients with cancer and their loved ones need to know about these findings?

They should know that our research indicates that it is possible to omit cystoscopies during follow-up of high-grade non-muscle-invasive bladder cancer. Our final results regarding recurrence detection are expected to be published within a couple of months.

We are also looking a quality of life, cost-effectiveness and use of antibiotics in these patients’ follow-up with the Xpert Bladder Cancer Monitor instead of cystoscopy.

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