Faster, Less Expensive Bladder Cancer Test Studied at UR

Wilmot Urologists Lead Efforts to Improve Detection, Treatment of Common Cancer

February 15, 2005

A test to detect bladder cancer reduces anxious waiting for people concerned about the disease and may cut the number of invasive procedures to verify the presence of tumors  according to a study in today’s Journal of the American Medical Association (JAMA).  This study was done in part at the University of Rochester Medical Center.

In a study, the NMP22 BladderChek® Test was almost three times as effective as cytology, standard laboratory-based urine test, in diagnosing bladder cancer.  NMP22 is a nuclear matrix protein found in urine, but when the level is elevated in a urine sample, it’s a sign of bladder cancer.

When used with cystoscopy, the test detected 94 percent of the bladder cancers, compared to 89 percent seen by cystoscopy alone. In addition, the test identified four invasive, life-threatening cancers missed during cystoscopic examination. The study focused on 1,331 patients from 23 sites in 10 states, including 15 from Rochester, from September 2001 to May 2002. Bladder cancer was diagnosed in 79 patients.

“This advances our ability to diagnose bladder cancers more easily and less expensively,” says Edward M. Messing, M.D., one of the authors of the JAMA article, and chair of the Department of Urology at the University of Rochester Medical Center and deputy director of the James P. Wilmot Cancer Center.  The $30 urine test can be completed in less than an hour in an office setting.

Bladder cancer is the fifth most common malignancy in the U.S., with 63,000 new cases each year. Early detection is critical, as the five-year survival rate is 95 percent. There are several methods to detect bladder cancer, but none are 100 percent effective and doctors use a combination of them for accuracy.

Messing is an internationally renowned expert in bladder and prostate cancers. He previously demonstrated that screening for hematuria (blood in the urine) allows for early bladder detection, which set the standard for detection methods. Over the past eight years, he has led a dozen clinical trials on the detection and treatment of bladder cancer, with participation by more than 380 local people.

The JAMA study, which Messing helped design with colleagues at M.D. Anderson Cancer Center, focused on people who are at high risk for bladder cancer – those who smoked or had hematuria. 

Someone with hematuria will often undergo a flexible cystoscopy, an invasive, in-office procedure to examine the urethra and bladder with a thin, lighted scope.  If tumors exist, the patient would endure to a second procedure to remove the tumors, in an operating room.

“This test could significantly cut the need for cytology and reduce the number of flexible cystoscopies we perform to find tumors because we would know the cancer cells exist. Then we could schedule the cystoscopy procedure under anesthesia to remove the tumors in the operating room,” says Messing, who conducted initial studies of this test in 1998.

The BladderChek® test was developed by Matritech, which funded the research.

Messing is researching additional ways to improve the detection of recurrent bladder cancers, including the use of fluorescent dyes and blue light during cystoscopy, and another test using DNA markers to detect recurrent tumors.

Messing and other UR scientists are also studying the genetic background of bladder cancers in mice and testing whether interference with the expression of specific genes can prevent or treat bladder cancer.  Results could offer insight into the development of targeted therapies for this common cancer.

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Leslie White
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