Urothelial Carcinoma: Role of Biomarkers in Diagnosis, Prognosis and Treatment

Dear Colleagues,

The second most frequently diagnosed urological tumor worldwide is urothelial carcinoma (UC), which involves the bladder and upper urinary tract. Approximately 70-75% of the cases are non-invasive or low grade. Urine cytology and cystoscopy are the basic methods for the investigation of hematuria. If abnormal tissue is cystoscopically found, then a transurethral biopsy is recommended. Although cystoscopy is the gold standard for the diagnosis of UCs, there are two disadvantages: it is invasive and costly. On the other hand, cytology is less sensitive for low-grade tumors. The success of treatment is correlated with the detection of UCs in the early stages. Moreover, recurrence and progression dominate the natural history of UC. Hence, there has been a lot of research in order to identify biological markers for the diagnosis of UC in order to fill the gap of cystoscopy and urine cytology, therefore leading to the era of precision medicine. Many biomarkers have been studied in different clinical situations such as prognosis, diagnosis and treatment. However, there are some drawbacks in finding the appropriate biomarkers that are validated and utilized in clinical practice. First, the detection of a reliable marker is difficult due to a lack of accuracy. Secondly, the process of validation is too complex to be introduced into daily clinical practice, and finally, they must be evaluated into preclinical as well as prospective studies in larger cohorts. Therefore, the current American Urological Association (AUA) and European Association of Urology (EAU) guidelines draw attention against the use of biomarkers instead of cystoscopy and urine cytology. Clearly, it is of great interest to identify new potential biomarkers which will facilitate the management of patients suffering from UC, meaning that these markers will allow for a reliable and timely diagnosis, treatment and prognosis.

Dr. Ioannis Zachos
Dr. Panagiotis Vlachostergios
Guest Editors

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