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Bladder Cancer

Bladder Cancer

Bladder cancer is the most common malignancy of the urinary tract. It is caused by abnormal cell growth leading to a mass of tissue (tumour) in bladder lining. Based on the GLOBOCON analysis, the estimated number of newly diagnosed cases in 2012 were 429,000 patients and 165,000 bladder cancer related deaths. Limited treatment options as well as the invasive nature of cystoscopy that is used for life-long monitoring of the patients, decreases patient‘s life expectance and quality of life and make bladder cancer the most costly cancer to treat.


Bladder cancer stages

Depending on the level of infiltration of the cancerous cells through layers of bladder wall, bladder cancer is characterised as: a) Non-muscle invasive (NMIBC; Stages Ta, T1, CIS) and Muscle invasive (MIBC: Stages T2, T3, T4). 

Risk factors

  • Cigarette smoking – considered as a main risk factor for bladder cancer. Cigarette smoking is associated with half of bladder cancer cases.
  • Working environment - Exposure at workplace to carcinogenic chemicals such as aromatic hydrocarbons, aromatic amines and chlorinated hydrocarbons, especially in the various parts of industry
    (i.e. production of dyes, rubber, textile, leather or chemicals)
  • Age, Gender – Risk of developing bladder cancer increase with age and bladder cancer is more frequently detected in men than in women, with men to women incidence ratio at around 3:1
  • Medical history of the patients including presence of urinary tract infections, schistosomiasis, previous treatment (radiotherapy, chemotherapy).

Symptoms of Bladder Cancer

Hematuria (presence of blood in urine) is a first sign of early stage bladder cancer. As tumour advances, other symptoms may appear including increase frequency and painful urination or unexpected need to urinate. In the case of the infiltration of the tumour into muscle layer, pelvic and bone pain, loss of weight, inability to urinate or swelling of feet may occur.

Early diagnosis and monitoring is of paramount importance

At initial diagnosis the vast majority of bladder cancer patients (70-80%) present with NMIBC, 20-30% have MIBC with approximately 5% exhibiting clinically evident distant metastases. With the treatment options being limited, basically radical cystectomy is the main option for treating muscle invasive disease, the outcome is very poor  and more than 50% of the patients with MIBC disease, deceasing within 5 years. At the same time, NMIBC is related with very high recurrence rates of  up to 78%. Therefore, early detection is of paramount importance to improve disease outcome.

Up to now, the diagnosis of bladder cancer is performed using cystoscopy. The accuracy in detecting BC is not always sufficient, while the procedure is highly invasive. Based on the high numbers of cystoscopies that are carried out during the follow-up period, bladder cancer remains one of the most expensive and most uncomfortable cancer type worldwide. Unnecessary and unpleasant cystoscopies and the associated risks can be prevented using the BCa-PROteom Test.

DiaPat® BCa-PROteom Test/ BCa-FollowUP Test

The BCa-PROteom Test/ BCa-FollowUP Test is a novel gentle method to  diagnose bladder cancer using highly sophisticated techbnologies. By screening with the BCa-PROteom Test/ BCa-FollowUP Test, the disease can be timely detected at early stages where more treatment options are possible. 

Benefits of screening by DiaPat
The five-year survival average rate of bladder cancer is 77%. Early and timely detection followed by therapy, increases the chances of recovery to 96.2% at early stage.

DiaPat screening is also suitable for aftercare:
The relapse rate in bladder cancer is particularly high  up to 78%. Therefore a follow-up session for the early  re-emerging tumors in 1st and 2nd year after treatment  should be initiated every 3 months. This decrease in invasive diagnostic procedures clearly reduces patients‘ discomfort during the follow-up and remarkably increases  the patients‘ quality of life



The DiaPat® BCa-PROteom Test/ BCa-FollowUP Test and the application of the DiaPat Technology in bladder cancer have been described in several publications:

Frantzi M, Van Kessel KE, Zwarthoff EC, Marquez M, Rava M, Malats N, Merseburger AS, Katafigiotis I, Stravodimos K, Mullen W, Zoidakis J, Makridakis M, Pejchinovski M, Critselis E, Lichtinghagen R, Brand K, Dakna M, Roubelakis MG, Theodorescu D, Vlahou A, Mischak H, Anagnou NP. Development and validation of urine-based peptide biomarker panels for detecting bladder cancer in a multi-center study. Clin Cancer Res. 2016 Mar 29 

Frantzi M, Latosinska A, Flühe L, Hupe MC, Critselis E, Kramer MW, Merseburger AS, Mischak H, Vlahou A. Developing proteomic biomarkers for bladder cancer: towards clinical application. Nat Rev Urol. 2015 Jun;12(6):317-30.

Latosinska A, Frantzi M, Vlahou A, Mischak H. Clinical applications of capillary electrophoresis coupled to mass spectrometry in biomarker discovery: Focus on Bladder Cancer. Proteomics Clin Appl. 2013 Dec;7(11-12):779-93.


Siwy J, Vlahou A, Zimmerli LU, Zürbig P, Schiffer E
Clinical proteomics: Current techniques and potential applications in the elderly
Maturitas. 2011 Mar;68(3):233-44

Schiffer E
Urinary proteomics: ready for prime time in urological cancer diagnostics?
Personalized Medicine 2011, Jan;8 (1): 81-94

Schiffer E.
The 2nd annual oncology biomarkers conference.
Biomark Med. 2009 Apr;3(2):203-9.

Schiffer E, Vlahou A, Petrolekas A, Stravodimos K, Tauber R, Geschwend JE, Neuhaus J, Stolzenburg JU, Conaway MR, Mischak H, Theodorescu D
Prediction of Muscle-invasive Bladder Cancer Using Urinary Proteomics
Clin Cancer Res. 2009 Aug 1;15(15):4935-43

Schiffer E, Mischak H, Zimmerli LU
Proteomics in gerontology - current applications and future aspects
Gerontology. 2009;55(2):123-37.

Schiffer E, Mischak H, Theodorescu, Vlahou A
Challenges of using mass spectrometry as a bladder cancer biomarker discovery platform
World Journal of Urology 2008, 26(1): 67-74

Wittke S, Schiffer E, Bauer HW
Kapillarelektrophorese gekoppelte Massenspektrometrie zur Proteomanalyse: Eine innovative diagnostische Methode bei Prostata- und Blasenkrebs
Der Urologe 2007, 46(7): 733-739

Mischak H
Hochauflösende Proteomanalyse aus Urin in der nicht invasiven Diagnostik von Tumoren und chronischen Erkrankungen
prevention and anti aging 2006, 2(4): 426-435

Theodorescu D, Wittke S, Ross MM, Walden M, Conaway M, Just I, Mischak H, Frierson HF
Discovery and validation of new protein biomarkers for urothelial cancer: a prospective analysis
Lancet Oncol. 2006, 7(3): 230-240

Kolch W, Mischak H, Pitt AR
The molecular make-up of a tumour: proteomics in cancer research
Clin Sci (Lond). 2005, 108(5): 369-383


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