Articles

Letter to the Editor

Reply to Tommaso Cai, Nicola Mondaini, Riccardo Bartoletti and Sandra Mazzoli's Letter to the Editor re: Paula M.J. Moonen, Judith M.J.E. Bakkers, Lambertus A.L.M. Kiemenay et al. Human Papilloma Virus DNA and p53 Mutation Analysis on Bladder Washes in Relation to Clinical Outcome of Bladder Cancer. Eur Urol 2007;52:464–9

By: Johannes Alfred Witjes

European Urology, Volume 53 Issue 1, April 2008

Published online: 01 April 2008

Abstract Full Text Full Text PDF (38 KB)

Refers to article:

Human Papilloma Virus DNA and p53 Mutation Analysis on Bladder Washes in Relation to Clinical Outcome of Bladder Cancer

Paula M.J. Moonen, Judith M.J.E. Bakkers, Lambertus A.L.M. Kiemeney, Jack A. Schalken, Willem J.G. Melchers and J. Alfred Witjes

Accepted 7 November 2006

August 2007 (Vol. 52, Issue 2, pages 464 - 469)

Refers to article:

Re: Paula M.J. Moonen, Judith M.J.E. Bakkers, Lambertus A.L.M. Kiemenay et al. Human Papilloma Virus DNA and p53 Mutation Analysis on Bladder Washes in Relation to Clinical Outcome of Bladder Cancer. Eur Urol 2007;52:464–9

Tommaso Cai, Sandra Mazzoli, Nicola Mondaini and Riccardo Bartoletti

Accepted 25 September 2007

April 2008 (Vol. 53, Issue 4, pages 858 - 859)

The findings of Cai et al indeed are interesting and suggest a potential role of human papilloma virus (HPV) in bladder cancer development or detection.

The aim of our study, to which the authors refer, was more to evaluate association between high-risk HPV DNA, p53 status, and clinical outcome in patients with bladder cancer because p53 alone did not provide sufficient information in a previous study for clinical decision-making. Our study was exploratory. Although other studies have indicated that HPV has a relation with bladder cancer, these studies are rather small and, in part, not very recent. Therefore, we would not advise, as yet, basing screening or early detection on HPV status. Furthermore, as in other studies, also in our series no relation was found between HPV and progression, similar to no relation being found between HPV status and a reduction in cancer-specific survival, which is the ultimate goal of screening. Another argument not to screen high-risk patients is that we still do not know which tools are appropriate for screening for bladder cancer. For that, more data are needed to reliably assess diagnostic test characteristics such as positive and negative predictive value in specific indicated populations not only for HPV status, but also for other tests that are presently under evaluation for their efficacy for screening purposes (Hemastix, NMP22, Urovysion, Immunocyt, and microsatellite instability). Last but not least, there is no evidence whatsoever that bladder cancer screening has any impact on bladder cancer-specific survival. Currently, it would be unrealistic to expect that screening, which we are uncertain how to do and what the results might be, would improve bladder cancer-specific survival, even in high-risk HPV groups, for which again we do not know whether a clear relation with bladder cancer-specific death actually exists.

Conflicts of interest

The author has nothing to disclose.

Footnotes

Radboud University Nijmegen Medical Centre, Department of Urology, Netherlands

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