“In many ways the field of urine markers is evolving but it has also hit some obstacles,” says Yair Lotan, MD.
In this video, Yair Lotan, MD, University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center, discusses the session from the Bladder Cancer Advocacy Network (BCAN) 2023 Think Tank: “What is the clinical utility and potential for urine biomarkers?”
There are many goals for this session. First of all, I think in many ways the field is evolving but it has also hit some obstacles. Generally speaking, I've been doing urinary marker research for 20 years and there have been a large number of markers introduced, whether they be protein based, DNA, RNA, panels, multiplex-type testing, point of care, etc. And the guidelines have so far made fairly limited recommendations on the use of urine markers. For example, there are no recommendations for use in hematuria, which is a very common condition that urologists evaluate. And there are only limited uses in evaluation of patients with atypia on cytology or abnormal cystoscopy, or possibly to help as a prognostic tool in patients undergoing BCG. But no recommendations to be used widespread in surveillance—certainly not to replace cystoscopy. And there's obviously questions about why there is a gap in the number of tools we have for potential usage in detection, surveillance, and prognostication, and the actual clinical benefit being demonstrated such that it's involved in the guidelines. So for example, prostate cancer relies on PSA, which is a pretty flawed marker that has been criticized for decades and has been given different recommendations by the US Preventative Services Task Force, sometimes a D, sometimes a C, but a lot of different genetic and quite expensive markers have been added to the armamentarium when managing prostate cancer, and those markers don't necessarily perform that much better than the urine markers. But yet there's issues not only with adoption [of urine markers] but also with getting the appropriate levels of evidence and getting coverage.
So I think our goal during this session is to highlight the current state of the art—discuss what levels of evidence would be necessary to for these markers to be included in the guidelines and more importantly, to demonstrate utility for patients. We’ll also discuss a little bit about potential uses. Screening is not recommended for bladder cancer, could urine markers play a role there? Prognostication and risk stratification really isn't something that we use markers for, but could next generation sequencing markers or some of the other markers provide a benefit there? And there are some trials that are ongoing. There's a randomized trial with CX bladder for hematuria that might help change the field or provide the level of evidence necessary to be added to guidelines. So our hope is to sort of present data and then have an open discussion with people who are attending the session to try to identify the next steps in adoption of urinary markers.
Transcript has been edited for clarity.