Screening for bladder tumours in men aged 60-70 years with a bladder tumour marker (UBC) and dipstick-detected haematuria using both white-light and fluorescence cystoscopy.

OBJECTIVE

To investigate the relevance of bladder tumour screening using haematuria dipsticks and a bladder tumour marker in a random selection of men, age 60-70 years, from a well-defined geographical area using both fluorescence and white-light cystoscopy.

MATERIAL AND METHODS

A total of 2000 randomly selected men, age 60-70 years, were invited by mail to participate in a screening for bladder tumours by having their urine tested with a dipstick for haematuria and a bladder tumour marker (UBC). Men with 5-10 red blood cells (RBC)/microl and an International Prostate Symptom Score (IPSS) of >10 and all men with =25 RBC/microl and/or elevated UBC levels underwent both white-light and fluorescence cystoscopy.

RESULTS

A total of 1096 men (55%) responded and were included in the study. The incidence of 5-10 RBC/microl was high: 14%. A tumour was detected in one of the 62 men with 5-10 RBC/microl and an IPSS of >10. Among the 10% of men (n=112) with =25 RBC/microl, four bladder tumours were detected. Another two tumours were detected in men without haematuria (positive UBC test). No tumours were observed using only fluorescence cystoscopy.

CONCLUSIONS

Fluorescence cystoscopy and the UBC test were of no use in this screening situation. The incidence of haematuria (=5-10 RBC/microl) was so high (1:4) that this borderline for bladder tumour screening appears unrealistic. The incidence of =25 RBC/microl was 1:10 and one of 28 cystoscopies revealed a bladder tumour. All seven tumours were detected in men who were or had been smokers. A haematuria-based screening among older male smokers with =25 RBC/microl on dipstick testing is thus an option that should be considered.