Date Published: July 25, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Angela Lamarca, Jorge Barriuso.
Bladder cancer has increased incidence during last decades. For those patients with nonmuscle involved tumors, noninvasive diagnosis test and surveillance methods must be designed to avoid current cystoscopies that nowadays are done regularly in a lot of patients. Novel urine biomarkers have been developed during last years. Telomerase is important in cancer biology, improving the division capacity of cancer cells. Even urinary telomerase could be a potentially useful urinary tumor marker; its use for diagnosis of asymptomatic and symptomatic patients or its impact during surveillance is still unknown. Moreover, there will need to be uniformity and standardization in the assays before it can become useful in clinical practice. It does not seem to exist a real difference between the most classical assays for the detection of urine telomerase (TRAP and hTERT). However, the new detection methods with modified TeloTAGGG telomerase or with gold nanoparticles must also be taken into consideration for the correct development of this diagnosis method. Maybe the target population would be the high-risk groups within screening programs. To date there is no enough evidence to use it alone and to eliminate cystoscopies from the diagnosis and surveillance of these patients. The combination with cytology or FISH is still preferred.
Bladder cancer is a very frequent and aggressive malignant tumor. During 2011, it has been the fourth most frequent malignancy diagnosed in men and the ninth in women. Worldwide, the mortality of this tumor, three times higher in men than in women, was around 113000 deaths in men during the year 2011. The incidence increases significantly with the age, so the age-adjusted incidence rate for people under 65 years is 5,35 per 100000 habitants, and 119,76 per 100000 in people over 65 years .
The most common presenting symptom of patients with bladder cancer is asymptomatic microscopic hematuria or the painless macrohematuria. The percentage of symptomatic patients is difficult to say because most times the symptoms are intermittent and nondetected. Nevertheless, the early diagnosis methods based on urinary markers of bladder malignancies have been developed during the last year. There is hope to use them as early predictor of the disease, and also for the surveillance, so we could avoid the regular cystoscopy usually used for the control of the relapse of nonmuscle invasive bladder cancer [7, 8].
Urine is in continuous contact with the urothelium from the renal pelvis and calyxes ureters, bladder and urethra. Thus, looking for biomarkers of malignant disease in the urine makes sense.
The role of the telomere and the telomerase in the pathogenesis of cancer has been widely studied [32–34].
Telomerase is activated in 80–90% of human carcinomas . The knowledge acquired by basic studies on telomere biology is being applied on the study of cancer and the development of telomerase-targeted therapies [39, 40].
Even urinary telomerase could be a potentially useful urinary tumor marker, depending on sensitivity and specifity in predetermined patients. Its use for diagnosis in symptomatic patients or its impact during surveillance is still unknown. Moreover, there will need to be normalization and standardization of the assays before they can become useful in clinical practice. Maybe the target population in whom we could use it will be in high-risk groups screening programs or as diagnosis or for surveillance programs. Nowadays there is no enough evidence to use it alone, and the combination with cytology or FISH is preferred, having said that, there is no sufficient data to avoid periodical cystoscopy.