Despite the latest study on the TERT test, Dr. Konety said he continues to typically use cystoscopy, cytology, and FISH to monitor for recurrence in these patients.
“People have been trying to develop a urinary marker for the last maybe 30-plus years. There have been a ton of markers that have been investigated and many trials run. Still, marker use has not caught on,” Dr. Konety said.
The reason? How to best use these tests isn’t clear, according to Dr. Konety.
“If we’re going to do cystoscopy on everybody, and we feel that cystoscopy is really reliable and is probably the best test, then, if you really want to replace it, you better get a test that is really, really close to cystoscopy,” he said. “As studies suggest, patients are telling us that some other test has to be 90% to 95% sensitive before they’re willing to give up cystoscopy. They don’t mind undergoing the discomfort of a 10-minute procedure, as long as they know it will tell them if they have something to worry about.”
If urologists are going to use the TERT or other test as an adjunct, then it has to have the specificity of cytology but improve upon its sensitivity, he said.
“Specificity of cytology is over 90%. And none of the other tests have come up to that level of specificity, while retaining a very high level of sensitivity,” he said.
Where a test, such as the TERT test, might also be highly useful is in people with blood in their urine, to test for bladder cancer and potentially avoid computed tomography scans and cystoscopy, according to Dr. Konety.
“That would be very beneficial because it’s a good area to focus on. Again, the test parameters have not yet gotten to that level. But they may get there,” he said.
The study was funded by the French Ministry of Health. Dr. Konety is involved in studies on tumor markers with Genomic Health.
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