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Inching Towards a World With Fewer Cystoscopies

As a diagnostic tool to confirm or rule out bladder cancer, the cystoscopy (along with cytology urine tests) have long been considered the gold standard. But cystoscopies are uncomfortable at best and painful at worst. They are invasive and they increase the risk of urinary tract infections.1 I’ve never heard anyone say they look forward to a cystoscopy.

A new diagnostic urine test

Bladder cancer patients will therefore likely welcome the news that a newer diagnostic test is becoming more widely available. It is a urine test called Cxbladder made by New Zealand-based Pacific Edge Limited. And clinical research has suggested that — because of its improved accuracy over cytology — it may reduce the for need cystoscopies to confirm or rule out the presence of bladder cancer.2

The dilemma of “atypical cytology”

You may have experienced it yourself. Or, if you follow discussions among bladder cancer patients online, you have likely heard of it. The “it” is a urine test result that shows “atypical” cells. This “atypical cells” result is based on a urine cytology test.

“Atypical” is an incredibly frustrating and unhelpful result. It is telling the patient that his or her cells are not normal, but that doesn’t necessarily mean they are cancerous. Essentially, it is telling the patient that something is wrong, but we’re not sure just how wrong. A result like this usually requires a cystoscopy to figure out what’s going on in the bladder.

European Association of Urology found the Cxbladder test more reliable than cytology

European Urology, the journal of the European Association of Urology, is a monthly peer-reviewed medical journal covering urology. In 2019, the journal published research results that showed that Cxbladder outperformed cytology and allowed some patients to avoid a cystoscopy.3 The research also found that Cxbladder could help confirm results associated with an “equivocal” (or uncertain) cystoscopy.3

A possible alternative to cystoscopies

The article concluded: “Significant utility is gained from the inclusion of Cxbladder in the evaluation of patients for UC in both hematuria and monitoring settings, with 35% of patients avoiding cystoscopies. Cxbladder, either as a reflex to cytology or as a replacement for cytology, would remove the diagnostic dilemma associated with atypical cytology results and equivocal cystoscopy.”3

Kaiser Permanente and the CMS approved the use of Cxbladder

In June, the non-profit Kaiser Permanente healthcare system approved the use of the test for its members. Members could receive a urine-test kit at home and send the sample directly to the lab for analysis.4 In July, the Centers for Medicare and Medicaid Services (CMS) also began covering the Cxbladder tests.5

Bladder cancer patients may not see an immediate change in their monitoring regimen. But this certainly seems like a hopeful sign that we are slowly moving away from uncomfortable and invasive tests for detecting and monitoring bladder cancer.

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