Study Shows New Test Better at Detecting Bladder Cancer
Tuesday, January 17, 2006
A simple in-office urine test significantly increases detection of recurrent bladder cancer, finding 99 percent of tumors when used with cystoscopy, according to a report in today’s Journal of the American Medical Association. The NMP22 BladderChek® test was studied at the University of Rochester Medical Center’s James P. Wilmot Cancer Center.
“This test is an important tool for doctors – early detection of bladder cancers improves treatment options and patient outcomes,” says Edward M. Messing, M.D., Chair of Urology at the Medical Center and an author of the report. “Delay of diagnosis of an aggressive bladder cancer even by a few months can affect prognosis.”
Bladder cancer affects more than a half-million people in the United States and is the most common form of cancer to recur. More than half, and as many as 90 percent, of people treated for bladder cancer see the cancer return, sometimes within weeks of treatment.
Last year, Messing and colleagues around the nation reported in JAMA that the NMP22 BladderChek® Test was earlier reported to be three times more effective than the standard laboratory-based urine test. It assesses the level of NMP22, a nuclear matrix protein found in urine. An elevated level is a sign of bladder cancer.
When used with cystoscopy – an invasive test using a flexible scope to see inside the urethra and bladder -- the test detected 99 percent of the bladder cancers, compared to 91 percent seen by cystoscopy alone. In addition, the test identified eight of nine invasive, life-threatening cancers missed during cystoscopic examination.
The study focused on 668 patients with a history of bladder cancer from 23 sites in nine states, including 20 from Rochester, between September 2001 and February 2002. Bladder cancer was diagnosed in 103 patients.
“This advances our ability to diagnose bladder cancers more easily and less expensively,” said Messing. The $30 urine test can be completed in less than an hour in an office setting, which lets anxious patients get an answer quickly.
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 400 Rochester area patients.
The JAMA study, which Messing helped design with colleagues at M.D.Anderson CancerCenter, University of Miami and Rhode Island Hospital, focused on people who are at the highest risk for bladder cancer – those who had a history of bladder tumors.
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 scopes during cystoscopy, and two other molecular tests; one using DNA markers to detect recurrent tumors, and the other using the RNA of a cancer cell survival molecule to detect new 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.