Ask the Doctor

Spring 2008

Our questions for this issue of Outlook were answered by Dr. Badrinath Konety, Associate Professor, Departments of Urology, Epidemiology and Biostatistics, University of California, San Francisco. We sincerely appreciate his sharing his opinions and impressions with us.

Q. Have there been any new developments regarding the nuclear protein BLCA-1 or BLCA-4 as markers for bladder cancer? Are there any other new markers on the horizon to help detect low grade bladder cancer?

A. Currently work is ongoing to validate BLCA-1 and BLCA-4 as diagnostic markers for bladder cancer. Sample collections have been completed from large groups of patients with either suspicion of or prior history of bladder cancer and these samples are being analyzed to determine the accuracy of these markers. Work is ongoing to develop more easy to use formats to perform the tests for these proteins.

There are other markers as yet not available in the United States, such as the Urinary Bladder Cancer (UBC) test and the CYFRA 21-1 test which detect specific proteins in the urine of bladder cancer patients. These tests are commercially available in Europe and have been used to monitor the results of chemotherapy in those with advanced bladder and lung cancer with reasonable effectiveness. Other tests that are promising and in development are tests to detect the proteins survivin and hyaluronic acid/hyaluronidase and telomerase.

Q. We understand that you are involved in research on age-specific therapies for those diagnosed with non-invasive bladder cancer. Can you share with us any findings to date in this area?

A. We have examined the association between age and results of treatment for non muscle invasive bladder cancer and found that older patients, particularly those more than 70 years of age do not tend to respond as well to intravesical BCG therapy as younger individuals. This may have to do with the fact that the immune system grows weaker with age. Since the action of BCG is dependent upon generating a strong immune response, a limited immune response as often seen in older individuals, may not be sufficient to control the growth or recurrence of tumors treated with BCG in these individuals. Other strategies to boost the immune response or use of intravesical chemotherapy following failure of BCG may be necessary.