Screening for bladder tumours in men aged 60-70 years with a bladder tumour marker (UBC) and dipstick-detected haematuria using both white-light and fluorescence cystoscopy

Abstract

Objective: To investigate the relevance of bladder tumour screening using haematuria dipsticks and a bladder tumour marker in a random selection of men, age 60-70 years, from a well-defined geographical area using both fluorescence and white-light cystoscopy.

Material and methods: A total of 2000 randomly selected men, age 60-70 years, were invited by mail to participate in a screening for bladder tumours by having their urine tested with a dipstick for haematuria and a bladder tumour marker (UBC). Men with 5-10 red blood cells (RBC)/microl and an International Prostate Symptom Score (IPSS) of >10 and all men with =25 RBC/microl and/or elevated UBC levels underwent both white-light and fluorescence cystoscopy.

Results: A total of 1096 men (55%) responded and were included in the study. The incidence of 5-10 RBC/microl was high: 14%. A tumour was detected in one of the 62 men with 5-10 RBC/microl and an IPSS of >10. Among the 10% of men (n=112) with =25 RBC/microl, four bladder tumours were detected. Another two tumours were detected in men without haematuria (positive UBC test). No tumours were observed using only fluorescence cystoscopy.

Conclusions: Fluorescence cystoscopy and the UBC test were of no use in this screening situation. The incidence of haematuria (=5-10 RBC/microl) was so high (1:4) that this borderline for bladder tumour screening appears unrealistic. The incidence of =25 RBC/microl was 1:10 and one of 28 cystoscopies revealed a bladder tumour. All seven tumours were detected in men who were or had been smokers. A haematuria-based screening among older male smokers with =25 RBC/microl on dipstick testing is thus an option that should be considered.