Urine Test Detects New, Recurrent Bladder Cancer

Date: December 17, 2014

It’s not a substitute for surveillance cystoscopy and transurethral bladder biopsy, but a new urine test developed at Johns Hopkins may soon become part of the arsenal for detecting bladder cancer, picking up recurrent cancer and predicting aggressive tumors, says Trinity Bivalacqua, director of urologic oncology.

The test looks for mutations in the promoter of the telomerase reverse transcriptase (TERT) gene. A multidisciplinary team led by genitourinary pathologist George Netto, along with scientists from the Ludwig Cancer Research team, and Bivalacqua and Mark Schoenberg,  found a very high prevalence of TERT promoter mutations in a wide range of precursor bladder tumors. 

“We knew it had the potential to be useful in early diagnosis,” says Bivalacqua. “Then we wondered if this biomarker could also pick up the return of bladder cancer after treatment.” The scientists looked for TERT mutations in early tumors, follow-up urine samples from patients who developed recurrent bladder cancer and patients who did not have recurrent cancer. Among patients whose tumors harbored TERT promoter mutations, the same mutations were present in follow-up urine samples in those who developed a recurrence—but not in the urine of patients whose cancer did not recur. 

 “The real value of this test,” Bivalacqua notes, “is to be able to predict aggressive cancers from the more indolent cancers that don’t need invasive treatments.” This work was published in Cancer Research.

Momentum in bladder cancer: “There’s a new wave of bladder cancer research at Johns Hopkins,” says Bivalacqua. The institution recently opened the Greenberg Bladder Cancer Institute, funded with the help of philanthropists Erwin L. and Stephanie Cooper Greenberg. Netto received a Greenberg grant to support his urinary biomarker research, and Bivalacqua has received funding for research on genetically engineered mouse models of bladder cancer and to investigate new forms of nanoparticle delivery of chemotherapeutic agents and novel immunotherapies to treat noninvasive bladder cancer. “This has really allowed us to grow our research and treatment programs,” says Bivalacqua. “Bladder cancer has not received the attention it deserves. We are changing that now.” 

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