We are in a day and age where every week a new medically related discovery is made and not infrequently, this results in another new test. The challenge for the field of clinical medicine going forward is to better and more adequately assess the true usefulness of all these new tests before beginning to use them on patients. In simple terms, we need to separate true, scientifically proven benefit from novelty and ‘hype.’
Specific to urologic cancers, we are fortunate that among the most useful tests remains the easiest for the patient and among the oldest, testing their urine. Long gone, thankfully, are the days when the practitioner would need to taste the urine to diagnose diabetes, replaced by the ability to quickly and reliably check for the presence of red blood cells as well as other factors that would be a signal of underlying disease.
Cancers of the urinary tract are most often diagnosed after patients present with either the complaint of having seen blood in the urine or having it be recognized microscopically.
Should everyone be screened with regular urine testing? The answer, not surprisingly, is no. It is much more important for patients with risk factors to be selectively screened. In days gone by, these were more commonly individuals with exposure to a myriad of chemicals in their workplace in both industrial and manufacturing jobs. Today, though, the greatest ‘offender’ in terms of exposure is cigarette smoke, not only for the person smoking but also for the people exposed to the smoke. This exposure is the most frequent cause of bladder cancer, an important cause of cancer death in America.
We have shown that the death rate from bladder cancer is increased when treatment is delayed. This is also true for some cases of prostate cancer. Although screening with a simple blood test measuring prostate-specific antigen levels remains an area of great controversy, over time it is likely that its role in the reduction of prostate cancer mortality in the last 25 years by almost 50 percent will be better established.