Below is a good video for understanding urine bio-marker like FISH by Urovision. FISH is FDA approved urine biomarker test, which was approved in 2005, a bit old technology. There are several new urine bio-markers that are better than FISH, but not all are FDA approved.
1. Only 5 -10% of patients who come to a urologist's office are bladder cancer. 90-95% chance that you do not have bladder cancer according to Dr. Black -the speaker.
2. AUA guideline states that Fish has 73% sensitivity (when FISH is positive, 73% has bladder cancer) and 95% specificity ( when FISH is negative, 95% has no bladder cancer) when FISH is used for diagnosis.
3. Sometimes it can pick up when cystoscopy misses because of Carcinoma Insitu (CIS) or the tumor is in the upper part of the ureter.
4. Urologists are using cytology more than urine bio-marker as it can pick up what cystoscopy misses. Dr. Black, the speaker once said that he does cytology every time he does cystoscopy. If cytology says negative, it is almost certain that there is not cancer. But if cytology says positive and cystoscopy is negative, he has to look for the source.
I am guessing that if Dr. Black - the speaker in the video is your urologist, I would think that he would recommend cytology first as it is not invasive. If it is negative, he would say that you less likely have cancer because cystoscopy also showed negative.
If cytology is positive, he may ask for Bluelight cystoscopy, which can highlight carcinoma-in-situ better than white light cystoscopy. But this is invasive and not all hospitals have Bluelight cystoscopy, especially flexible cystoscopy which has become available recently.
If the upper section of the ureter needs to be checked, another cystoscopy needs to be done unless your urologist already did it. This is invasive too.
Not all descriptions may not be correct, but hope it helps you to prepare for the meeting with your doctor.
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