Aim: The prospective study UroScreen aims to
assess whether bladder tumours are recognized
more readily in a high-risk population by the
use of urinary tumour markers than by haematuria
or abnormal cytology.
Method: Since 2003, UroScreen has been included
in the medical surveillance programme
carried out according to the guideline G33.
Once annually, 1772 workers with previous
exposure to aromatic amines are offered the
quantitative determination of nuclear matrix
protein NMP22 and survivin and the UroVysionTM
test for chromosomal aberrations in addition
to urinalysis and cytology.
Results: As of February 2009, 1600 subjects had
been enrolled in at least one screening session.
For the 5785 urine tests, positive results were
found in 199 (3.5 %) NMP22 assays, 113 (2.3 %)
survivin assays, especially in subjects with urinary
tract infections (UTI) which are considered
as a criterion for exclusion of the NMP22 test but
cannot always be handled in this way. UTI occur
commonly in medical practice but compliance
for control investigations is poor. Positive
results in the UroVysionTM test were obtained
for 55 (1.0 %) of samples, in some cases together
with abnormal cytology findings. For samples
yielding positive results in the tests, including
cytology but excluding survivin, cystoscopy was
recommended. To date, 15 tumours have been
found in 14 subjects, and for 11 of them a positive
test result had been obtained in the preceding
marker screening. The protein-based (NMP22,
survivin) and cell-based tests (UroVysionTM, cytology)
complemented each other here.
Conclusions: The preliminary UroScreen results
indicate that a marker panel with protein- and
cell-based markers can improve early detection
of bladder cancer. The experience gained
through this extensive prospective study could
also help in the resetting of cut-offs for quantitative
markers and in deciding when to recommend
invasive cystoscopy.
