Can Urine Test Can Detect Bladder Cancer Early
Bivalacqua: Test could be a much-needed
alternative to invasive follow-up procedures.
When bladder cancer reaches the muscles, it is often fatal. However, in its first stages, the cancer just perches on the lining of the bladder, and this is the time when it is most curable. But early detection is a problem, notes Trinity Bivalacqua, M.D., Ph.D., Director of Urologic Oncology. “Although we have a urine test that is able to detect highgrade, more advanced cancers of the bladder, its performance in detecting early precursor tumors that have the potential to become more aggressive is poor.” Several new urine tests have come on the market, but they haven’t proven reliably accurate or consistent, and so are not in widespread use.
“This test has great potential to save many lives.”
Unfortunately, the need for a better test has never been greater. Not only is more bladder cancer being diagnosed, but the vexing nature of this cancer is that it tends to come back after treatment. The best way now for urologists to detect and monitor bladder cancer is with invasive procedures, including cytoscopy and transurethral bladder biopsy. “Because of the high r ate of tumor recurrence, we have to perform frequent follow-up cystoscopy procedures,” says Bivalacqua, “but this results in an unacceptable rate of invasive procedures and ballooning costs. In the U.S., the management of bladder cancer has the highes t cost burden per patient among all tumor types, with an estimated $3 billion per year total cost to the health care system.”
Good news: Hopkins scientists have discovered a better test. It has to do with mutations in the promoter of the telomerase reverse transcriptase (TERT) gene. A multidisciplinary team of Hopkins scientists, led by George Netto M.D. a genitourinary pathologist and Professor of Pathology and Urology, along with Bert Vogelstein, Nickolas Papadopolous, Louis Diaz and Ken Kinzler, from the Ludwig Cancer Research Team, working closely with Brady urologists including Bivalacqua and Mark Schoenberg M.D., found a very high prevalence of TERT promoter mutations in a wide range of precursor bladder cancers. “These are the most common genetic alterations ever identified in early bladder cancer,” says Netto. Could a test for TERT mutations also pick up the return of bladder cancer after treatment? The group looked for these mutations in a series of early tumors and also in follow-up urine samples from patients who developed recurrent bladder cancer and others who did not have recurrent cancer. Among patients whose tumors harbored TERT promoter mutations, the same mutations were present in follow-up urines in those who developed a recurrence but not in the urine of patients whose cancer did not r ecur.
“These exciting results strongly support the potential future analysis of TERT promoter mutations as a urine tes t that can facilitate the early diagnosis of bladder cancer, before it spreads deep into the bladder wall, in patients at high risk for disease progression,” says Bivalacqua. “The test will also give us a noninvasive alternative to the many follow-up procedures we currently need to monitor our patients for recurrence of bladder cancer. This test has great potential to save many lives.” This work was published in Cancer Research.