Researchers from the M. D. Anderson Cancer Center have reported that cystoscopy alone remains the most cost-effective method of detecting recurrent superficial bladder cancer. The details of this study were presented at the 2010 American Society of Clinical Oncology Genitourinary Cancers Symposium March 5-7 in San Francisco.[1]

Bladder cancer is common; approximately 55,000 new cases are diagnosed in the United States each year. Superficial bladder cancer refers to cancer that has not spread to muscles of the bladder or nearby lymph nodes. Recurrence of superficial bladder cancer is common and often involves cancer invading the muscle of the bladder. Surgery is then required to remove the cancer.

Patients who have undergone initial treatment for superficial bladder cancer often receive follow-up cystoscopies to detect a recurrence. A less invasive way to detect bladder cancer recurrence is urinary cytology. However, cystoscopy misses a fairly high proportion of low-grade (less aggressive) cancers. Given the limitations of both procedures, researchers are exploring tests that are less invasive than cystoscopy and more accurate than urinary cytology. There have been several candidate tests for screening for bladder cancer. One such FDA-approved test measures nuclear matrix proteins and is called NMP22 BladderChek®. UroVysion™ is another test that was approved in 2001 to be used in conjunction with cystoscopy for the monitoring of a recurrence in patients with bladder cancer. UroVysion™ is a DNA probe assay that utilizes fluorescence in situ hybridization (FISH) methods for detecting genetic changes in bladder cells from urine specimens.

The current study was carried out to determine the relative costs of several approaches to screening for recurrent superficial bladder cancer. Two-hundred patients in this study underwent cystoscopy, cytology, NMP22 Bladder Chek, and FISH UroVysion testing. These authors evaluated five different strategies:

1. Transurethral resection of a bladder tumor (TURBT) for positive cystoscopies
2. TURBT for positive cystoscopy or NMP22 testing
3. TURBT for positive cystoscopy or FISH Urovysion testing
4. TURBT for positive cystoscopy or positive NMP22 testing “confirmed” by positive Urovysion testing
5. TURBT for positive cystoscopy or positive NMP22 testing “confirmed” by positive  Urovysion testing

There were 13 patients in this study with recurrent superficial bladder cancer. Cystoscopy detected all 13 recurrences. The costs for the five strategies per tumor detected were:

1. $7,692
2. $12,000
3. $26,500
4. $11,800
5. $21,300

These authors concluded that cystoscopy alone was the most cost-effective method of detecting recurrent superficial bladder cancer. They concluded: “The addition of urinary markers adds to cost, without increase in tumor detection.”

Comments: This is an important study given the fact that cytology and the NMP22 and FISA Urovysion appear to be widely used techniques for detecting recurrent bladder cancer. These results will need to be validated by other investigators.

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