FIG. 19:  So should we use markers for every patient?  No; we cannot ignore cystoscopy.  Patients with a tumor on cystoscopy do not need a marker because we know what to do; we have to take the patient to the operating room. 

But what if there are atypical findings?  Then markers may have a significant role because they may be able to clarify these situations.  Patients who have atypical findings are concerned, and the clinician is concerned about a possible missed cancer. 

But what if the cystoscopy is normal?  In this setting, the role of a marker is unclear because while it is possible that the marker might identify cancers that are missed by cystoscopy, this is very hard to prove.