FIG. 7:  There are several different approaches for urine-based tumor markers.  One  approach uses biochemical detection of proteins or other urinary compounds.  An example of this is nuclear matrix protein 22 (NMP22); BladderChek^® (Alere) is a commercially available test for this assay.  Another approach detects cellular antigens by immunohistochemistry or cytochemistry, for example, with ImmunoCyt™ (Diagnocure). 

Genetic alterations in cells can be detected, for example with the UroVysion^® fluorescence in situ hybridization (FISH) assay. 

Other assays look at RNA content in the urine; i.e. Xpert^® Bladder Cancer Monitor and Cxbladder™. 

Finally several assays based on changes in methylation have been developed, AssureMDx™ and Bladder EpiCheck^®.