Patients choose certainty over burden in bladder cancer surveillance

Frits Van Osch, Duncan Nekeman, Neil Aaronson, Lucinda Billingham, Nicholas James, Kar Cheng, Richard Bryan, Maurice Zeegers

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
116 Downloads (Pure)


Background: Due to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker.

Methods: We studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, nonparametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics.

Results: Almost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories.

Conclusions: Our results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance.
Original languageEnglish
Pages (from-to)2747-2753
Number of pages7
JournalWorld Journal of Urology
Issue number12
Early online date23 Mar 2019
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
With thanks to all participating clinicians and their staff from within the West Midlands region for their continued support: P. Cooke, K. Jefferson, H. Krasnowski, J. Parkin, B.D. Sarmah, P. Ryan, R. Bhatt, M. Foster, K. Desai, L.A. Emtage, K.W. Kadow, C. Luscombe, S. Khwaja, and A. Makar. We would also like to recognise the invaluable contribution made by the BCPP nursing, research and administrative staff to the programme: A. McGuire, C. Langford, C. Letchford, C. Slater, C. Taylor, D. Bird, G. Heritage, H. Shackleford, J. Sears, J. Maiden, J. Goodall, J. Allison, J. Hutton, J.Y. Robinson, K. Castro, L.R. Moore, L. Benson, M. Grant, R. Abid, S. Collins, T. Martin, and T. Coles. In addition, we thank R.C. Reulen for his substantial help with data management and the West Midlands Cancer Intelligence Unit for providing data on patients with bladder cancer in the West Midlands. BCPP is supported by Cancer Research UK (grant number: CRUK/05/28).

Publisher Copyright:
© 2019, The Author(s).


  • non-muscle-invasive
  • bladder cancer
  • non-invasive biomarkers
  • sensitivity and specificity
  • standard gamble
  • Standard gamble
  • Non-invasive biomarkers
  • Non-muscle-invasive bladder cancer
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Urology


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