ANDREADIS SPEAKING

NEW YORK (Reuters Health) Nov 13 - The urine matrix metalloproteinase (MMP) level can be used to differentiate disease-free patients from those with recurrent bladder cancer, according to a report in the November issue of The Journal of Urology.

MMP detection in the urine correlates with the disease status of various neoplasms, including bladder cancer, the authors explain.

Dr. Anthony P. Shuber from Predictive Biosciences, Inc., Boston, and colleagues measured and compared MMP-2, MMP-9, and MMP-9/neutrophil gelatinase-associated lipocalin (NGAL) in urine samples from 446 cancer-free subjects and 84 patients with bladder cancer. Many of the cancer-free subjects had urologic disease and some had a history of bladder cancer but no current evidence of disease.

MMP-2, MMP-9, and MMP-9/NGAL concentrations were significantly higher in the cancer group than in the cancer-free group, the authors report.

The researchers used a novel Clinical Intervention Determining Diagnostics (CIDD) method to identify MMP cutoffs that could distinguish, with near 100% certainty, patients who require no further follow-up from those who would benefit from more intensive clinical intervention.

For example, using CIDD for MMP-9 levels at 98% negative predictive value, 42% of cancer-free individuals could be spared cystoscopy, whereas the remainder could continue to receive standard of care monitoring.

"By adding multiple biomarkers CIDD could result in stratifying a patient population into 3 categories," the investigators say, "including 1) patients found not to have cancer with extremely high negative predictive value, as we describe, 2) a population found to have cancer with extremely high positive predictive value, and 3) a group for which the standard of care would be most appropriate."

"CIDD may be applied to other biomarker assays and other diseases with a high recurrence rate," the authors conclude. "Applying CIDD to these markers would establish new threshold levels that provide information on whether patients should be included in accelerated monitoring or excluded from the next scheduled standard of care screen."

J Urol 2009;182:2188-2194.