CxBladder Test For Surveillance

7 months 2 weeks ago #60580 by Bills
Replied by Bills on topic CxBladder Test For Surveillance
Hi Joea
Thanks for a detailed answer. I also like you am not able to access the site from my pc since the website has been updated. I many times reached IT support of this site but they always replied they are working on this issue. I am accessing website forum from my mobile as there is some issue with website content management through my pc.
Hope they resolve the issues soon.
Again as always I am greatly greatly thankful to you and Sara for your replies and advices
Thanks and Respect.
The following user(s) said Thank You: joea73

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7 months 2 weeks ago #60579 by joea73
Replied by joea73 on topic CxBladder Test For Surveillance
I cannot use the attachments function. I have tried different browsers. It used to work with the previous version of the website. Maybe my pc environment is incompatible with the new website. Please, someone, check it the attachments function works.
So, I will attach the links to explain histology and three urine analysis - cytology, FISH, and cxBladder.

Histology, also known as microscopic anatomy or microanatomy, is the branch of biology that studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures visible without a microscope - (Wikipedia)

Histology is what a pathologist applies to look at samples that a urologist obtains during TURBT. The pathologist determines the stage (Ta, T1) for non-muscle invasive tumor and (T2 and above) for muscle-invasive tumor. Also, the pathologist determines the grade (low grade or high grade) for non-muscle invasive tumors.

Below is a normal bladder.

Below is high grade.

Below is CIS

Note that in the early-stage, CIS does not go beyond the basement membrane

Urine Analysis



cxBladder Triage is typically used for hematuria patients to see if it is caused by bladder cancer. If the score is > 4, it recommends cystoscopy.

CxBladder Detect seems to be used to detect if bladder cancer exists by looking at genes of 5 bladder cancer-related genes.

CxBladder Monitor seems to compare the past test and the present test and predict the recurrence.

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7 months 2 weeks ago #60578 by joea73
Replied by joea73 on topic CxBladder Test For Surveillance
cxBladder is a urine test to predict if the patient has bladder cancer. cxBladder was developed by the company called Pacific Edge in New Zealand. I have noticed it has been more mentioned and used in the US since Medicare had approved cxBladder. Currently available urine analysis for bladder caners are described below.

Cytology relies on a pathologist to look at fragments of urothelial cells in the urine using a microscope by finding abnormal-looking cells or a block of cells and predicting with high accuracy if there are high-grade / CIS bladder cancers. Also, they can find low-grade bladder cancers but the accuracy is not high. Cytology has a much longer history of being used for diagnosing bladder cancer than cystoscopy. Incidentally, histology is the analysis of cancer samples that were obtained by a urologist during the TURBT procedure. The pathologist decides the grade and the stage of the sample and reports the result to the urologist.

FISH or uFISH has been around for more than 15 years. It is another urine analysis. It was developed and sold by Abbot - a US medical device company. The brand name of FISH is UroVysion. FISH stands for Fluorescence In Situ Hybridization. The urine which contains urothelial cells is mixed around and goes through proprietary chemical analysis to find abnormal chromosome 3, 7, 17 and if chromosome 9 position 21. The chemical processed urothelial cells highlight in the fluorescent red, green, aqua, and gold if abnormal chromosomes 3,7,17, and 9P21 are found respectively. Note that abnormalities in chromosomes 3,7,17 and 9p21are often found in bladder cancer cells. When FISH has developed almost 20 years ago, not many gene analyses were done for bladder cancer back then. So, I think they needed to depend on the analysis of chromosomes. So, we can say FISH is a bit old technology.

In 2004, the first complete human genome analysis was completed. In 2015, a paper was published, which analyzed genes that were found in invasive bladder cancer patients. Today, over 300 genes have been identified in bladder cancer.

cxBladder is a newer urine analysis that is based upon gene analysis.
It uses 5 different genes, which are known to show up in high numbers in bladder cancers.
cxBladder has two protocols. One is cxBbadder Triage and the other is cxBladder Monitor.
cxBladder Triage which is used to check if the urine contain cancer cells. cxBladder monitor is used to check if reccurence had happened in between cysoscopy, especially for high grade and CIS.

Both cxBladder Triage and Monitor chek if the urothelial cells found in the urine have high concentration of 5 bladder cancer causing genes - IGFBP5, HOXA13, MDK, CDK1, and CXCR2.

For Monitor, The formula to predict the exisitense of bladder cancer is G-Index = (0.79 × IGFBP5 – 1.60 × HOXA13 + 2.10 × MDK + 0.95 × CDK1 – 0.38 × CXCR2) .
The higher the total, the higher the possiblity that we find a cancer in the bladder. If the multiplier is possitive, the gene is tumor promotor gene. If the multipler is negative, the gene is tumor suppressor. In other word, the higher concentration of IGFBP5 is, the higher probability that there is a cancer in the bladder. The higher concentration of HOXA13 is, the less chance that there is a cancer in the bladder. Monitor protocol has high probability to be right to predict the existence of high grade /CIS cancer in the bladder.

But, that formula does not give sufficiently predictability, which can be used in clinical setting, the existense of low grade blader cancer. So, for Triage, to improve accuracy they added a phenotype or qualitative values comprising of age(>65), smoking history, male or female, frequency of gross hematuria

P Index = −3.78 + (0.81 × Age + 0.46 × Gender + 0.78 × Smoking history + 0.59 × Hfreq). The higher P-index is
the higher the probabiity of existence of cance in the bladder. So, if you are over 65, male, with smoking history and had multiple gross hematuria, P-INDEX = -3.78+0.81+.46+0.78+0.59 = -.1.14. If you are under 65, female, never smoked, no gross hematuria, P-Index = -.3.78. Then you add P-Index to G-Index. If the total score is 0, definetily no cancer in the bladder exist. If the score is 10, it is almost certain, the cancer is advanced and can be already metastatic. If it is less than 4, it is likely no cancer or low grade if it does exisit. If it is less than 4, there will be no need for cystoscopy. So, for hematuria for example, as Sara had mentioned, cxBladder can be used instead of cystoscopy which is more invasive and more expensive. Anyway, that is how Pacific Edge wants to increase the use of cxBladder in clinical setting.

I will post next the pictures of Histology (pathology), cystology urine analys, UroVysion (Fish), cxBladder for the reference . For some reasons, I cannot attach the pictures.

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8 months 6 days ago #60553 by Bills
Replied by Bills on topic CxBladder Test For Surveillance
Thanks Mike for a detailed reply. I really appreciate your advise.
We had a cystoscopy in coming tuesday with biopsy to check the upstaging. I hope that all goes well.
Had a all clear in first cystoscopy in Nov. Hopefully I pray that all is well this time as well.
Thanks to all members of this forum
You guys are doing a wonderful job

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8 months 1 week ago #60536 by mikequestions
Replied by mikequestions on topic CxBladder Test For Surveillance
Hi Bills,

For my last cystoscopy, I took a good look at the equipment. I'd say it's about 1/8 to 3/16" in diameter and flexible - slightly larger than a small, flexible catheter. I found the first cystoscopy rather painful, but insisted on lidocaine (of which they gave me a double dose) on my follow-up cystoscopy. The insertion is not fun, but it's relatively quick, and it's over in no time, and did not have near the pain when they pulled it out. You'll get to know where your prostate is located, as this is the constriction point of the insertion. I'd be sure to request lidocaine for this procedure.

As has been mentioned, urination can be somewhat painful following the cystoscopy. The pain subsides quickly afterward.


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8 months 2 weeks ago #60513 by Alan
Replied by Alan on topic CxBladder Test For Surveillance
A cystoscopy for most guys is an annoyance. Everyone's pain threshold is different. Personally, I call it something pretty uncomfortable and short of real pain as it passes through the prostate. I have told myself it is maybe 15-20 seconds and once it is in the bladder it is less "uncomfortable". The only bad part for me is the first void is usually sharp "razor" blade feeling but, that also was over after voiding.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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