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To the Editor: In their study of the relevance of urine telomerase for bladder cancer detection, Dr Sanchini and colleagues¹ report that the TRAP assay was accurate in discriminating men with bladder cancer from healthy age-matched controls.

In previous studies, the suitability of the TRAP assay has been hampered by its widely varying sensitivity, presumably due to the instability of telomerase activity in urine.² Sanchini et al¹ did not encounter these problems, but they describe that about 7% of study participants had insufficient material for cytology, and 23% of cancer patients bypassed cytology examination. Thus, not all participants received the same reference standard, and the study design must therefore be regarded as suboptimal.³

In addition, the authors chose a narrow spectrum of healthy men as controls, which limits the generalizability of their results. Urine-based tests may have excellent specificity in healthy populations but fail to accurately discriminate between benign conditions . . . [Full Text of this Article]

Steffen Weikert, MD
steffen.weikert@charite.de

Frank Christoph, MD; Kurt Miller, MD
Department of Urology
Charité-University Medicine Berlin
Campus Benjamin Franklin
Berlin, Germany

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