Considerations on the use of diagnostic markers in management of patients with bladder cancer.

Although the incidence of bladder cancer lags behind that of other malignancies, it has the highest rate of recurrence among all US malignancies. The propensity to recur and the possibility of disease progression require aggressive surveillance, which has led to bladder cancer being the most expensive malignancy to treat in the United States. Current non-tailored surveillance strategies applied uniformly to all patients with non-muscle invasive bladder cancer may impose excessive diagnostic burden on patients with low-grade disease for the sake of adequately monitoring those with potentially aggressive disease. The recent identification of several bladder cancer tumor markers has led to attempts to determine if these markers can enhance existing surveillance strategies by possibly tailoring surveillance strategies to individual patients. These markers may result in cost savings by properly identifying which patients can safely delay cystoscopy and which patients require more periodic assessment. Furthermore, we may be able to identify those patients with "occult disease" that require more invasive assessments and earlier aggressive treatment. We will review diagnostic considerations in the use of these markers for the detection of recurrent bladder cancer and summarize the benefits and costs of the more promising bladder cancer markers.