There remains a lack of consensus among guideline relating to which patients require investigation for haematuria. We determined the incidence of urinary tract cancer in a prospective observational study of 3556 patients referred for investigation of haematuria across 40 hospitals between March 2016 and June 2017 (DETECT 1; ClinicalTrials. gov: NCT02676180) and the appropriateness of age at presentation in cases with visible (VH) and nonvisible (NVH) haematuria. The overall incidence of urinary tract cancer was 10.0% (bladder cancer 8.0%, renal parenchymal cancer 1.0%, upper tract transitional cell carcinoma 0.7%, and prostate cancer 0.3%). Patients with VH were more likely to have a diagnosis of urinary tract cancer compared with NVH patients (13.8% vs 3.1%). Older patients, male gender, and smoking history were independently associated with urinary tract cancer diagnosis. Of bladder cancers diagnosed following NVH, 59.4% were high-risk cancers, with 31.3% being muscle invasive. The incidence of cancer in VH patients <45 yr of age was 3.5% (n=7) and 1.0% (n=4) in NVH patients <60 yr old. Our results suggest that patients with VH should be investigated regardless of age. Although the risk of urinary tract cancer in NVH patients is low, clinically significant cancers are detected below the age threshold for referral for investigation.
This study highlights the requirement to investigate all patients with visible blood in the urine and an age threshold of ≥60 yr, as recommended in some guidelines, as the investigation of nonvisible blood in the urine will miss a significant number of urinary tract cancers. Patient preference is important, and evidence that patients are willing to submit to investigation should be considered in reaching a consensus recommendation for the investigation of haematuria. International consensus to guide that patients will benefit from investigation should be developed.
European urology. 2018 Apr 10 [Epub ahead of print]
Wei Shen Tan, Andrew Feber, Rachael Sarpong, Pramit Khetrapal, Simon Rodney, Rumana Jalil, Hugh Mostafid, Joanne Cresswell, James Hicks, Abhay Rane, Alastair Henderson, Dawn Watson, Jacob Cherian, Norman Williams, Chris Brew-Graves, John D Kelly, DETECT I trial collaborators
Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: ., UCL Cancer Institute, London, UK., Surgical & Interventional Trials Unit, University College London, London, UK., Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK., Division of Surgery and Interventional Science, University College London, London, UK; UCL Cancer Institute, London, UK., Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK., Department of Urology, James Cook University Hospital, Middlesbrough, UK., Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, UK., Department of Urology, East Surrey Hospital, Redhill, UK., Department of Urology, Maidstone Hospital, Maidstone, UK., Department of Urology, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, UK.