gms | German Medical Science

Since 40 years in urological practice we have no change in daily routine procedures concerning diagnostic schedules of bladder cancer. With the focus on bladder cancer urologists become active, only when symptomatic person’s visit our offices. This is fixed in the EAU guidelines for bladder cancer and the trias of macrohematuria, chronic microhematuria or chronic bladder urge is described aspotential reasons for invasive diagnostics. A non-invasive practice is not defined or mentioned.This is the background forthe following questions: In which UICC distribution do we really diagnose bladder cancer concerning the primary diagnosis? What is the actual curing rate after five years after diagnosis? Do we have new possible strategies in bladder cancer diagnostics to become better in tumour detection andoutcome for our patients?

Based on available epidemiological data from Germany we must consider that the number of diagnosed bladder cancer patients is increasing -in the last decade from 16.000 to 24.700 in 2004.The UICC distribution at the time of primary diagnosis hasn’t changed.25% up to 33% of our newly diagnosed bladder cancer patientssuffer froma stage II ormore invasivecancer, meaning for Germany that 6175 to 8151 patients will loose their bladderby curative cystectomyorwill diein the next two years because of a primary palliative tumour status at time of diagnosis. Thus the focus of our interest must be mainly the asymptomatic risk persons. Three risk factor groups are worked out with personal risk by age and gender, the smoking risk by smoking behaviour during lifetime and the occupational risk by toxin exposure during daily work. It will be demonstrated how the interactive formula RiskCheck© will offer the opportunity toexamine every patient for its personal risk situation and to inform him on this. On this basis we will be able to focus our non-invasive diagnostic strategy on a defined risk population to become more cost-effective without mass screening. With available urine soluble tumour markers as NMP22 in the form of the BladderCheck™ POC test -Matritech GmbH, Freiburg- such a strategy can be managed easily. With a published sensitivity of 56% up to 80% we can win the capacity to prevent about 3000 to 5000 persons per year in Germany to be diagnosed in invasive or even palliative tumour stage, when a consequent preventive care takes place over the next four to seven years.

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