Background: Urinary bladder cancer is one of the major health problem all over the world. Cystoscopy remains the gold standard for identifying bladder cancer but it is invasive and expensive, therefore, a simple, non invasive test for detecting bladder cancer would be helpful. Several biomarkers for bladder cancer have been used, but no single marker has been accurate and conclusive.
Aim: The current study aimed to measure telomerase enzyme in urine as a useful non invasive marker for detection of bladder cancer.
Methods : Forty eight patients ( 39 males and 9 females) were included, They are complaining of urinary symptoms and undergo cystoscopy with biopsy of bladder lesions and histopathological examination. They were divided into groups: Group I: 16 patients ( 11 males and 5 females) have benign urologic conditions. Group II: 32 patients (28 males and 4 females) have proven bladder cancer patients underwent transurethral resection of bladder tumor or cystoscopy with biopsy of bladder lesions. Also, 15 apparently healthy volunteers with matched age and sex with patients were served as a control group. All subjects were submitted to laboratory estimation of the following in urine: urinary creatinine, urine cytology, telomerase enzyme in urine by telomerase PCR and complete urine examination.
Results : The results of this study revealed that a highly significant increase in the frequency of cytolological positive cases for tumor cells in malignant group than each of benign group and healthy subjects, while no significant difference was detected between benign group and healthy subjects. The frequency of telomerase in urine was significantly higher in malignant group than each of benign group and healthy subjects, while no significant difference was detected between benign group and healthy subjects. The telomerase activity has sensitivity of 90.6% for diagnosis of cancer bladder with 93.7% for specificity and PPV was 96.6%, NPV was 83.3% and diagnostic accuracy of 91.6%. While, urine cytology gives a sensitivity of 68.8%, specificity of 87.5%, PPV of 91.6%, NPV 58.3% and diagnostic accuracy of 75%. When combined tests were used the sensitivity raised to 96,8%, and specificity reached to 100%, PPV was 96.6%, NPV was 94.1% and diagnostic accuracy increased to 97.9%.
Conclusion: the urinary assay of telomerase could be used as non invasive test to identify the bladder cancer patients and distinguish them from normal subjects and patients with benign tumor of urinary bladder. The low cost of this test may help to be implicated as non invasive screening of bladder cancer.