Lotan - Figure 30

Conclusions

FIG. 30:  In conclusion, what can we conclude about the current use of markers?  First, the current indications for use of markers are limited.  The guidelines suggest that they can be used as reflex testing in patients with equivocal cystoscopy or atypical cytology.  There may also be a role in predicting responses to intravesical therapy such as BCG, but this requires further validation. 

We need trials that define the clinical roles of the biomarkers.  Can we identify markers with a very high negative predictive value so that we can avoid cystoscopy in select patients?  Can we find highly sensitive markers that detect cancer in patients with hematuria so we can expedite evaluation in patients who need to be triaged for rapid evaluation of hematuria and possibly avoid cystoscopy in those at low risk?  Finally, can we identify those patients who are likely to respond to therapy?  This way, we can identify those who might not respond and offer them clinical trials or removal of the bladder earlier than they might otherwise have.

References

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