Urinary cholesterol in cancer screening

Cholesterol determinations in morning urine samples were taken in 235 selected patients with a positive test for microscopic hematuria. Values ranged from 0.2 to 76.0 mg (median 5.5) in 23 patients with urologic malignancies and from 0.1 to 33.4 mg (median 1.1) in 38 patients with various benign diseases of the kidney or urogenital tract. In the 28 patients with urinary tract infections and 146 subjects without evidence of disorders of the kidney and the urogenital system, urinary cholesterol excretion was usually normal (0.1 to 1.9 mg; median 0.35). Using 1.0 mg urinary cholesterol per morning urine as a cutoff point, sensitivity for urologic carcinomas is about 80 per cent with a comparable high specificity of 90 per cent. Therefore, subsequent measurements of urinary cholesterol in populations with microscopic hematuria could define two groups, one with high prevalence and one with low prevalence of urologic malignancies. The less complicated colorimetric instead of gas-liquid chromatographic determination of urinary cholesterol can be recommended as a screening test for urologic carcinomas in populations with microscopic hematuria

Studies on the clinical significance of nonesterified and total cholesterol in urine

Gas-liquid chromatographic determinations of nonesterified and total urinary cholesterol were performed in 137 normals, 264 patients with various internal diseases without evidence of neoplasias or diseases of the kidney or urinary tract, 497 patients with malignancies and 236 patients with diseases of the kidney, urinary tract infections or prostatic adenoma with residual urine. A normal range (mean±2 SD) of 0.2–2.2 mg/24 hours nonesterified cholesterol (NEC) and of 0.3–3.0 mg/24 hours total cholesterol (TC) was calculated. Values of urinary cholesterol excretion were independent of age and sex and did not correlate with cholesterol levels in plasma. Patients with various internal diseases, without evidence of neoplasias nor diseases of the kidney or obstruction of the urinary tract, showed normal urinary cholesterol excretions, as did patients with infections of the urinary tract. However, elevated urinary cholesterol was found in patients with diseases of the kidney or urinary tract obstruction (prostatic adenoma with residual urine), malignant diseases of the urogenital tract and metastasing carcinoma of the breast. In patients with other malignant diseases urinary cholesterol was usually normal. Lesions of the urothelial cell membranes are considered to be the most likely cause of urinary cholesterol hyperexcretion. The clinical value of urinary cholesterol determinations as a possible screening test for urogenital carcinomas in unselected populations is limited by lacking specificity, expensive methodology and low prevalence of the mentioned carcinomas, although elevated urinary cholesterol excretions have been observed in early clinical stages of urogenital cancers