Matritech-Randy
At the risk of quibbling about something perhaps only two of us care about, here goes.
I think your reasoning may be dogmatically correct but practically wrong.
Regarding the issue of cytology as the gold standard for bladder cancer, you may be right, but I'm scratching my head trying to figure how that could be. It seems to me that no matter what raises the suspicion of bladder cancer (blood in the urine, prior cancer, abnormal cytology,and BladderChek are probably the most frequent, in that order) the clinical consequence will be the same---urologist performs cystoscopy to visualize the bladder mucosa and obtain biopsy specimens. So, in effect, I would argue the cystoscopy is the gold standard. I agree cystoscopy may be positive less often than cytology. But in my way of thinking those are pointless if not false negative cytology tests from the clinical perspective. To think of it another way, what is a patient or a clinician to do with a positive cytology (or BladderChek test for that matter) but negative cystoscopy? Nothing except hopefully bring the patient back sooner for another cystoscopy. My point is that a positive cytology or Bladderchek test in itself would not affect treatment in any way I can imagine.
Regarding your argument that you would gladly pay for the Bladderchek every month, what do want to do when the test is positive? A similar line of reasoning has been all but debunked with PSA testing. The problem is that unless a disease is both curable when found at a certain stage and lethal if untreated in a defined time frame, then it is very hard to demonstrate clinical usefulness of a test to diagnose the condition.
Sorry to quibble.
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