Using Urinary Biomarkers in Urothelial Carcinoma of the Bladder and Upper Tracts

Bladder cancer is the most expensive cancer to manage yet available diagnostic tools continue to harbor many limitations. In fact, the gold standard tool in bladder cancer diagnosis and surveillance is cystoscopy, which is inconvenient, invasive, and expensive. To date, urinary biomarkers are not used routinely in the evaluation and surveillance of bladder cancer, despite the expanding number of available tests. The main limitation to their use is the lack of well-defined clinical benefit. A useful biomarker test needs to be accurate, easy, fast, cheap, and safe, but on top of all this has a clinical validity proven by a properly designed clinical trial. In this chapter, we discuss the available urinary biomarkers, the rationale for their use, their test characteristics, the possible clinical scenarios where they can be used, and the future directions for design of clinical trials to establish their clinical benefit.