This presentation considers follow-up after successful transurethral resection of a high-grade non-muscle-invasive tumour, with normal cystoscopy, followed by bacillus-Calmette-Guérin (BCG) therapy. Focusing on two possible outcomes, a positive cytology but a negative urinary biomarker result, versus positive biomarkers but a negative cytology, we discuss what the evidence and guidelines recommend and which test is more robust. PATIENT SUMMARY: Bladder cancer is usually assessed by examination of tissue taken from the bladder, either by surgery or by biopsy; however, trace elements in the urine, known as biomarkers, can also provide an assessment. The challenge arises when the two methods do not agree: the tissue sample is positive for cancer, but the biomarker is negative, or the reverse. For now, these authors conclude that the tissue examination is more reliable than the biomarker result.
