OBJECTIVES: With the advent of novel genomic and transcriptomic technologies, new urinary biomarkers have been identified and tested for bladder cancer (BCa) surveillance. To summarize the current status of urinary biomarkers for the detection of recurrence and/or progression in the follow-up of non-muscle invasive BCa patients, and to assess the value of urinary biomarkers in predicting response to intravesical Bacillus Calmette-Guerin (BCG) therapy. METHODS AND MATERIALS: A medline/pubmed© literature search was performed. The performance of commercially available and investigational biomarkers has been reviewed. End points were cancer detection (recurrence), cancer progression, and response to BCG therapy. RESULTS: The performance requirements for biomarkers are variable according to the clinical scenario. The clinical role of urinary biomarkers in the follow-up of non-muscle invasive BCa patients remains undefined. The FDA-approved tests provide unsatisfactory sensitivity and specificity levels and their use is limited. Fluorescence in situ hybridization (FISH) has been shown to be useful in specific scenarios, mostly as a reflex test and in the setting of equivocal urinary cytology. FISH and immunocytology could conceivably be used to assess BCG response. Recently developed biomarkers have shown promising results; upcoming large trials will test their utility in specific clinical scenarios in a manner similar to a phased drug development strategy. CONCLUSIONS: Current commercially available urinary biomarker-based tests are not sufficiently validated to be widely used in clinical practice. Several novel biomarkers are currently under investigation. Prospective multicenter analyses will be needed to establish their clinical relevance and value.

Department of Urology and Comprehensive Cancer Center Vienna General Hospital Medical University of Vienna Waehringer Guertel 18 20 1090 Vienna Austria

Department of Urology Fundació Puigvert Universidad Autónoma de Barcelona Barcelona Spain

Department of Urology Hôpital Pitié Salpétrière Assistance Publique Hôpitaux de Paris Sorbonne Université Paris France

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology The Mount Sinai Medical Center New York USA

Department of Urology University of Texas Southwestern Medical Center Dallas USA

Department of Urology Weill Cornell Medical College New York USA

Division of Urology Department of Surgical Sciences San Giovanni Battista Hospital University of Studies of Torino Turin Italy

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

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