Because of the heterogeneous behavior of superficial bladder cancer, the development of additional simple diagnostic and prognostic tests will be invaluable. The authors have demonstrated significantly elevated levels of urinary VEGF in patients with active bladder cancer. The sensitivity and specificity of urinary VEGF for diagnosing primary or recurrent bladder cancer were superior when compared with the results of cytology, which remains the most widely used noninvasive diagnostic investigation. These results and the authors' previous findings at the mRNA and protein level strongly implicate VEGF in the pathogenesis of bladder cancer recurrence and progression. The potential exists for anti-VEGF strategies in the treatment of, or prophylaxis against, recurrent superficial bladder cancer.