Athens, Greece ( Dr. Tan began this debate regarding the need for urinary biomarkers in the management of bladder cancer. According to Dr. Tan, urine biomarkers can be used for detection or for prognosis. There is a great need for them in bladder cancer, but especially in surveillance of non-muscle invasive bladder cancer (NMIBC), and much research is currently conducted in this field.

Urinary markers may be used to assess response to intravesical BCG. Several of the used biomarkers for this are Urovision, FISH, cytology, and Immunocyst. Abnormal Urovision at baseline, 6 weeks and 3 months is associated with risk of disease progression or recurrence.1

Urine biomarkers can also be used for a personalized approach to determine the choice of intravesical treatment. Various urologic guidelines recommend different intravesical treatment regimens depending on the risk of disease (Table 1). There has been some work using 9 cytokines to predict response to BCG (IL-6, IL-1ra, il-3, il-8. Il-12 (p70), il-18, IFN-g, TNF-a, and TRAIL),2  with very promising results.

Table 1 – Personalizing treatment of intravesical therapy:

SIU 2019 Personalizing treatment of intravesical therapy

One of the greatest advantages of biomarkers is that they are non-invasive, and they enable a risk stratified approach for bladder cancer surveillance. The use of biomarkers may, in fact, reduce the frequency of surveillance cystoscopy, which is a significant burden for the patients and for the healthcare system. For example, FGFR3 mutation has been shown to be associated with lower stage and grade of recurrence (p<0.001).3 Therefore, surveillance by FGFR3 mutation on voided urine may reduce the frequency of surveillance cystoscopy.

The future or urinary biomarkers will hopefully allow for personalized therapy for bladder cancer in diagnosis, treatment, monitoring and follow-up. Furthermore, the tumor immune profile will enable us to predict the risk of disease recurrence.4

In conclusion, urine biomarkers entail non-invasive testing and may be used to assess response to intravesical BCG. Urinary biomarkers will enable us to implement a personalized approach to determine the choice of intravesical treatment. In the future, a risk-stratified approach for bladder cancer surveillance will be feasible with the use of biomarkers. Therefore, urine biomarkers are most useful and should be used whenever possible. Figure 1 illustrates a perceived future algorithm for NMIBC adjuvant treatment pathways, demonstrating the important role that biomarkers will have.

Figure 1 – Future non-muscle invasive bladder cancer adjuvant treatment pathways: 

SIU 2019 adjuvant treatment pathways

Presented by: Wei Shen Tan, MBBCh, BSc, MRCS, PhD, University College London, United Kingdom  

Written by: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, New York, USA, Twitter: @GoldbergHanan at the 39th Congress of the Société Internationale d’Urologie, SIU 2019, #SIUWorld #SIU2019, October 17-20, 2019, Athens, Greece    

1. Chang SS, Boorjian SA, Chou R, et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. The Journal of urology 2016; 196(4): 1021-9.
2. Kamat AM, Briggman J, Urbauer DL, et al. Cytokine Panel for Response to Intravesical Therapy (CyPRIT): Nomogram of Changes in Urinary Cytokine Levels Predicts Patient Response to Bacillus Calmette-Guerin. Eur Urol 2016; 69(2): 197-200.
3. Kompier LC, van der Aa MN, Lurkin I, et al. The development of multiple bladder tumour recurrences in relation to the FGFR3 mutation status of the primary tumour. The Journal of pathology 2009; 218(1): 104-12.
4. Wong YNS, Joshi K, Khetrapal P, et al. Urine-derived lymphocytes as a non-invasive measure of the bladder tumor immune microenvironment. 2018; 215(11): 2748-59.