Role and efficacy of current biomarkers in bladder cancer

Abstract

In order to overcome the current limitations in the diagnosis, therapy and follow-up of bladder cancer (BCa), the detection of biomarkers in urine, tissue and blood has been proposed as essential components of the precision medicine. The introduction of these modern molecular tests may help to identify disease earlier, to risk-stratify patients, to improve the prediction of oncological outcomes and to optimize target therapies. On the other hand, the main limitation for their spread in clinical practice is the lack of evidence of a meaningful improvement in clinical decision-making due to their unsatisfactory performances. Recent Literature made a great effort with the aim to describe novel biomarkers and their potential role, but this jigsaw puzzle scenario makes difficult the orienteering into their correct uses and indications. We reviewed the current state of the art and the performance of available and most promising biomarkers. Despite some good results, especially regarding the improvement of sensitivity compared to urinary cytology in the diagnostic setting, the use of these molecules has not been yet introduced into daily clinical practice by international guidelines, because of both the difficulty in identifying the correct scenario of use and the lack of high-quality prospective trials, with a subsequent low level of evidence. Further prospective investigations and large international collaborations are needed to define the role of these promising biomarkers.