Enzyme activity helps detect bladder cancer

Measurement of telomerase activity in urine appears promising for the detection of bladder cancer in men, according to a study published last week in JAMA (2005; 294:2052-6). Italian researchers studied 218 men whose urine telomerase activity was determined using a highly sensitive telomeric repeat amplification protocol assay. The performance of the assay to detect urine telomerase activity was compared with urine cytology as an aid to early cancer detection.

Using a 50 arbitrary enzymatic unit cutoff value, the assay showed 90% sensitivity and 88% specificity. Specificity increased to 94% for those aged 75 years or younger. The same predictive capacity of activity levels was observed for patients with low-grade tumors or with negative cytology results. In particular, sensitivity was 93%, 87%, and 89% for tumor grades 1, 2, and 3, respectively.

Although the test is proven to identify low-grade tumors, it is not recommended for use in routine screening programs because of the low incidence of bladder cancer and should be aimed at high-risk subgroups, noted the authors, from Morgagni-Pierantoni Hospital, Forli.