Title:New Tumor Test for Better Bladders

Above: The simple test may reduce overtreatment and ease high cost for some bladder cancer patients. Tumors testing positive (like A) are twice as likely to recur and invade the muscle as negative tumors (like B). Alana Lelo (M’16, PHD’19) and Brent Harris, Associate Professor of Pathology

Georgetown researchers have developed a new diagnostic tool for bladder cancer that may reduce unnecessary treatment for patients with non-invasive tumors.

Bladder cancer is relatively common, and treatment is notoriously extensive, uncomfortable, and expensive. Because early stage lesions come back in two out of three cases, patients must return for frequent monitoring of the bladder wall. Post-surgery surveillance includes cysto – scopy, the insertion of a lighted optical scope into the urethra to examine the inside of the bladder. In cases when new lesions are found, 20 percent of those patients will develop an invasive cancer.

A research team from Georgetown and Denmark found that a fairly simple test significantly improves the identification of problematic bladder tumors versus noninvasive bladder lesions. The study, published in Clinical Cancer Research, validates the overexpression of the STAG2 gene as a biomarker for early stage bladder cancer to recur, become invasive, and spread.

Checking for STAG2 is a simple procedure for pathologists who routinely examine excised tumors, says the study’s senior author, oncology professor Todd Waldman, MD, PhD. His studies describe how to run the test, which could spare patients unneeded surveillance and aggressive treatment that can produce significant side effects.

Waldman and his colleagues have worked on a diagnostic test for years. This study summed up several of those clinical studies, concluding that using the test “offers additional twofold predictive discrimination,” Waldman says.

“We are closer to our goal of lowering the risk of both aggressive bladder cancer and oversurveillance and treatment side effects in bladder cancer patients,” he says. “In principle, it might be possible to reduce the frequency of post-resection surveillance and therapy in patients whose cancer is STAG2-negative, and, conversely, treat patients and keep up high frequency surveillance in patients who have positive test results.”

The study’s first author is Alana Lelo, an MD/PhD candidate at Georgetown University School of Medicine.