New methods for detection of bladder cancer.

Superficial bladder cancer is characterized by a high incidence of recurrence and a low risk of progression. Cystoscopy has been the mainstay for bladder cancer detection with additional information provided by urine cytology. Several new markers, including the BTA series of markers, NMP22 and FDP, have been approved for clinical use; numerous others continue to be evaluated. Markers help to detect clinically occult bladder cancer and to increase the interval of cystoscopic evaluation. The former indication emphasizes specificity (if a marker has high specificity, the marker-directed biopsies are frequently positive) and the latter, sensitivity (if a marker has high sensitivity, there is a low risk of deferring cystoscopy when bladder cancer is present). Because no marker or combination of markers has 100% sensitivity and 100% specificity, the selection of markers for clinical use rests on the desired objective and the performance characteristics of the available assays.