Dr. Konety said the study is good in that it has a moderate number of patients and is based on what research has clearly shown: Telomerase reverse transcriptase levels rise in people with bladder cancer.
For urologists managing these patients, however, there remain hurdles in the TERT test’s general use.
“I think we need to understand exactly how we can use this and whether these performance characteristics will hold out with a larger sample set,” Dr. Konety said.
Cystoscopy is the cornerstone of detection of non-muscle-invasive bladder cancer, he said.
“On top of cystoscopy, you could use adjuncts, such as cytology, which has been a mainstay for a long time. The advantage of cytology is if it’s positive you know there’s something there. If it’s negative, it could be wrong,” he added.
To clarify results from a cystoscopy and cytology, Dr. Konety said he might use the UroVysion Bladder Cancer Kit fluorescence in situ hybridization (FISH), which is a urine test.
“The FISH test is more of a genetic [test]. It looks for specific genetic mutations, or copy number changes for the genes,” he said. “We have found that to be particularly helpful if the cytology test comes back as atypical. The other place we use FISH is when you have a patient who had bacillus Calmette-Guérin for treatment of non-muscle-invasive bladder cancer, and we want to assess whether the patient is responding or not.”
There are other markers. Among them: Cxbladder; nuclear matrix protein number 22, or NMP22; and bladder tumor antigen, BTA.
“The BTA and NMP22 are slightly older markers which are protein based,” he said. “They’re really not very helpful in the context I just mentioned because proteins can be increased or decreased based on inflammation and a variety of other factors.”
Cxbladder, also a genetic test, looks for elevated expression of certain genes in the urine.
“It has a combination of five genes and also looks for one specific gene, which is only elevated in inflammation, which really helps determine if any changes in the urine are due to inflammation or cancer,” Dr. Konety said.
There’s yet another test called The ImmunoCyt/uCyt+, which can enhance cytology findings, he said.
“We use that sometimes, as well. It’s not easy to get hold of,” he said.