Screening for bladder tumours in men aged 60-70 years with a bladder tumour marker (UBC) and dipstick-detected haematuria using both white-light and fluorescence cystoscopy

Objective. To investigate the relevance of bladder tumour screening using haematuria dipsticks and a bladder tumour marker in a random selection of men, age 60 - 70 years, from a well-defined geographical area using both fluorescence and white-light cystoscopy. Material and methods. A total of 2000 randomly selected men, age 60 - 70 years, were invited by mail to participate in a screening for bladder tumours by having their urine tested with a dipstick for haematuria and a bladder tumour marker (UBC). Men with 5 - 10 red blood cells (RBC)/mu l and an International Prostate Symptom Score (IPSS) of > 10 and all men with >= 25 RBC/mu l and/or elevated UBC levels underwent both white-light and fluorescence cystoscopy. Results. A total of 1096 men (55%) responded and were included in the study. The incidence of 5 - 10 RBC/mu l was high: 14%. A tumour was detected in one of the 62 men with 5 - 10 RBC/mu l and an IPSS of > 10. Among the 10% of men ( n = 112) with >= 25 RBC/mu l, four bladder tumours were detected. Another two tumours were detected in men without haematuria ( positive UBC test). No tumours were observed using only fluorescence cystoscopy. Conclusions. Fluorescence cystoscopy and the UBC test were of no use in this screening situation. The incidence of haematuria (>= 5 - 10 RBC/mu l) was so high ( 1: 4) that this borderline for bladder tumour screening appears unrealistic. The incidence of >= 25 RBC/mu l was 1: 10 and one of 28 cystoscopies revealed a bladder tumour. All seven tumours were detected in men who were or had been smokers. A haematuria-based screening among older male smokers with >= 25 RBC/mu l on dipstick testing is thus an option that should be considered.