Abstract
Objectives
Irritative urinary symptoms and micro-hematuria are the common findings in bladder cancer patients. In this study, we investigated the use of urine microscopy and cytological examination for early detection of bladder cancer in patients with lower urinary tract symptoms (LUTS).
Methods
Male patients presented with LUTS to urology clinic were enrolled. Voiding symptoms were evaluated with international prostate symptoms score, and urine samples were collected for microscopy and cytological examination. Cystoscopy was performed in patients with microscopic hematuria, suspicious/malignant cells in urine or at the time of transurethral resection of prostate. Subjects, who had no indication and did not receive cystoscopy, were followed up in clinic for progress of symptoms, including gross hematuria and occurrence of bladder cancer.
Results
Nine hundred and eighty-eight patients were enrolled during the period of 2005–2007. Fifty-two (5.26%) urine samples were documented as atypical, and 936 (94.7%) were negative. There was no suspicious or malignant cytology result in this series. Micro-hematuria was noticed in six patients (0.61%). The mean follow-up time was 29.1 ± 12.5 months. One (0.10%) patient had bladder cancer 44 months after the first visit in the cohort, who had micro-hematuria, atypical urine cytology, but normal cystoscopy before diagnosis.
Conclusion
The prevalence rate of bladder cancer in male patients with LUTS is low. This study adds to information that microscopy and cytological examination are not useful to detect bladder cancer. Due to the economic concerns and burden of unnecessary investigations, the routine use of these tests is in doubt.
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Abbreviations
- LUTS:
-
Lower urinary tract symptoms
- CIS:
-
Carcinoma in situ
- IPSS:
-
International prostate symptoms score
- BPH:
-
Benign prostate hyperplasia
- TURP:
-
Transurethral resection of prostate
- PPV:
-
Positive predictive value
References
Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96
Hong Kong Cancer Stat 2006. Hong Kong Cancer Registry, Hospital Authority. http://www3.ha.org.hk/cancereg/. Cited 18 May 2010
Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M et al (2004) EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol 46(5):547–554
AUA Practice Guidelines Committee, authors (2003) AUA guideline on management of benign prostatic hyperplasia 2003, chapter 1: diagnosis and treatment recommendations. J Urol 170(2 pt 1): 530–547
Grossfeld GD, Carroll PR (1998) Evaluation of asymptomatic microscopic hematuria. Urol Clin North Am 25(4):661–676
Papanicolaou GN, Marshall VF (1945) Urine sediment smears as a diagnostic procedure in cancers of the urinary tract. Science 101(2629):519–520
Varkarakis MJ, Gaeta J, Moore RH et al (1974) Superficial bladder tumor. Aspects of clinical progression. Urology 4(4):414–420
Yip SK, Peh WC, Tam PC et al (1998) Day case hematuria diagnostic service: use of ultrasonography and flexible cystoscopy. Urology 52(5):762–766
Farrow GM, Utz DC, Rife CC et al (1977) Clinical observations on sixty-nine cases of in situ carcinoma of the urinary bladder. Cancer Res 37(8 Pt 2):2794–2798
Messing EM, Young TB, Hunt VB et al. (1995) Comparison of bladder cancer outcome in men undergoing hematuria home screening versus those with standard clinical presentations. Urology 45(3):387–396; discussion 396–397
Thompson IM (1987) The evaluation of microscopic hematuria: a population-based study. J Urol 138(5):1189–1190
Ritchie CD, Bevan EA, Collier SJ (1986) Importance of occult haematuria found at screening. Br Med J 292(6521):681–683
Hiatt RA, Ordoñez JD (1994) Dipstick urinalysis screening, asymptomatic microhematuria, and subsequent urological cancers in a population-based sample. Cancer Epidemiol Biomarkers Prev 3(5):439–443
Golin AL, Howard RS (1980) Asymptomatic microscopic hematuria. J Urol 124:389
Mohr DN, Offord KP, Owen RA et al (1986) Asymptomatic micro-hematuria and urologic disease. A population-based study. JAMA 256:224
Messing EM, Vaillancourt A (1990) Hematuria screening for bladder cancer. J Occup Med 32:838
Kroft SH, Oyasu R (1994) Urinary bladder cancer: mechanisms of development and progression. Lab Invest 71(2):158–174
Svatek RS, Lotan Y (2008) Is there a rationale for bladder cancer screening? Curr Urol Rep 9(5):339–341
Lotan Y, Svatek RS, Malats N (2008) Screening for bladder cancer: a perspective. World J Urol 26(1):13–18
Potter JM, Quigley M, Pengelly AW (1999) The role of urine cytology in the assessment of lower urinary tract symptoms. BJU Int 84(1):30–31
de la Rosette JJ, Hubregtse MR, Wiersma AM (1993) Value of urine cytology in screening patients with prostatitis syndromes. Acta Cytol 37(5):710–712
Hofland CA, Mariani AJ (2004) Is cytology required for a hematuria evaluation? J Urol 171(1):324–326
Lotan Y, Svatek RS, Sagalowsky AI (2006) Should we screen for bladder cancer in a high-risk population? a cost per life-year saved analysis. Cancer 107(5):982–990
Badalament RA, Hermansen DK, Kimmel M (1987) The sensitivity of bladder wash flow cytometry, bladder wash cytology, and voided cytology in the detection of bladder carcinoma. Cancer 60(7):1423–1427
Hong YM, Loughlin KR (2008) Economic impact of tumor markers in bladder cancer surveillance. Urology 71(1):131–135
Têtu B (2009) Diagnosis of urothelial carcinoma from urine. Mod Pathol 22:S53–S59
Daniely M, Rona R, Kaplan T (2007) Combined morphologic and fluorescence in situ hybridization analysis of voided urine samples for the detection and follow-up of bladder cancer in patients with benign urine cytology. Cancer 111(6):517–524
Marshall VF (1956) Current clinical problems regarding bladder tumors. Cancer 9(3):543–550
Lee R, Droller MJ (2000) The natural history of bladder cancer. Implications for therapy. Urol Clin North Am 27(1):1–13
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Chan, E.S.Y., Ng, Cf., Hou, Sm. et al. Using urine microscopy and cytology for early detection of bladder cancer in male patients with lower urinary tract symptoms. Int Urol Nephrol 43, 289–294 (2011). https://doi.org/10.1007/s11255-010-9856-y
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DOI: https://doi.org/10.1007/s11255-010-9856-y