Test aids bladder cancer follow-up

A new protein test combined with cytoscopy can identify 99 per cent of all recurrences of bladder cancer, according to the results of a US study.

It may mean that testing for recurrence of bladder cancer can move from secondary care to primary care and be carried out by GPSIs in urology.

The study found that a simple test for nuclear matrix protein NMP22 together with cytoscopy was more accurate than using cytoscopy with cytology in 103 patients.

While cytoscopy identifies about 90 per cent of cancers, bleeding in the bladder can make identification less accurate and flat urothelial lesions may be hard to distinguish from normal tissue.

Cytological analysis of voided urine is therefore often used as well to identify tumours that are not obvious on cytology.

The NMP22 test is performed on four drops of voided urine dropped into an analysis device. The results are available 30-50 minutes later.

The researchers said that the NMP22 technique had advantages in that it did not require expert analysis or laboratory time, it was not dependent on cells surviving biopsy intact, it produced unambiguous results, and the procedure cost half as much as cytology.

Hertfordshire GP Dr Mike Kirby, who has a special interest in urology, said: 'At the moment patients who have had bladder cancer remain under surveillance and have an annual review in secondary care of cytoscopy and cytology.

'Cytoscopy and this new test, if it turns out to be specific and sensitive, could be carried out by a urology GPSI .'

JAMA 2006; 295: 299-305

BLADDER CANCER FACTS

- 10,600 new cases per year.

- Symptoms include: blood in urine, burning when passing urine, frequency of urination.

- 80-90 per cent chance of five-year survival for superficial bladder cancer.

- Recurrence is 50-90 per cent, depending on stage, grade and number of primary tumours.

Source: Cancer Research UK.

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