Context Dysregulation of apoptosis may favor onset and progression of cancer
and influence response to therapy. Survivin is an inhibitor of apoptosis that
is selectively overexpressed in common human cancers, but not in normal tissues,
and that correlates with aggressive disease and unfavorable outcomes.
Objective To investigate the potential suitability of survivin detection in urine
as a novel predictive/prognostic molecular marker of bladder cancer.
Design, Setting, and Patients Survey of urine specimens from 5 groups: healthy volunteers (n = 17)
and patients with nonneoplastic urinary tract disease (n = 30), genitourinary
cancer (n = 30), new-onset or recurrent bladder cancer (n = 46), or treated
bladder cancer (n = 35), recruited from 2 New England urology clinics.
Main Outcome Measures Detectable survivin levels, analyzed by a novel detection system and
confirmed by Western blot and reverse transcriptase polymerase chain reaction
(RT-PCR), in urine samples of the 5 participant groups.
Results Survivin was detected in the urine samples of all 46 patients with new
or recurrent bladder cancer using a novel detection system (31 of 31) and
RT-PCR (15 of 15) methods. Survivin was not detected in the urine samples
of 32 of 35 patients treated for bladder cancer and having negative cystoscopy
results. None of the healthy volunteers or patients with prostate, kidney,
vaginal, or cervical cancer had detectable survivin in urine samples. Of the
30 patients with nonneoplastic urinary tract disease, survivin was detected
in 3 patients who had bladder abnormalities noted using cystoscopy and in
1 patient with an increased prostate-specific antigen level. Patients with
low-grade bladder cancer had significantly lower urine survivin levels than
patients with carcinoma in situ (P = .002).
Conclusions Highly sensitive and specific determination of urine survivin appears
to provide a simple, noninvasive diagnostic test to identify patients with
new or recurrent bladder cancer.