A new study shows that routinely adding urine tests to cystoscopy unnecessarily increases the cost of monitoring for bladder cancer recurrence and the risk of a false-positive result. Cystoscopy – the examination of the inside of the bladder with a camera – is the current standard of care for surveillance of patients treated for early-stage bladder cancer. In recent years, urine tests for certain cancer biomarkers have been increasingly performed to increase the likelihood of detecting a recurrence early.

"Our findings suggest that rigorous screening with cystoscopy alone is the most cost-effective surveillance approach for patients with a history of bladder cancer," said lead author Jose Karam, MD, a urologic oncology fellow at The University of Texas M. D. Anderson Cancer Center. "Adding urine tests to ongoing cystoscopy could result in unnecessary procedures, and possibly unwarranted patient anxiety."

Patients treated for early-stage bladder cancer – in which the disease has not invaded nearby muscle – have a high risk of recurrence and are routinely monitored with cystoscopy every 3 to 6 months for life.

In this analysis, Dr. Karam and his colleagues compared the accuracy and cost per cancer detected (using Medicare 2009 reimbursement data) of the most common bladder cancer surveillance strategies -- cystoscopy alone and with the urine tests NMP22, FISH, cytology, and NMP22 plus FISH to confirm abnormal NMP22 -- in 200 patients with a history of bladder cancer. Cystoscopy alone was associated with the fewest false-positives (two), while cystoscopy plus FISH was associated with the most false-positives (30).

Cystoscopy alone was also the least expensive test ($7,692 per cancer detected), followed by cystoscopy with NMP22 confirmed by FISH ($9,557), cystoscopy plus cytology ($10,267), cystoscopy plus NMP22 ($11,143), and cystoscopy plus FISH ($19,111).


Source: ASCO