The incidence and rate of recurrence of bladder cancer is high, particularly in 
developed countries, however current methods for diagnosis are limited to 
detecting high-grade tumours using often invasive methods. A panel of biomarkers 
to characterise tumours of different grades that could also distinguish between 
patients exhibiting the disease with first incidence or recurrence could be 
useful for bladder cancer diagnostics. In this study, potential metabolic 
biomarkers have been discovered through mass spectrometry based metabolomics of 
urine. Pre-treatment urine samples were collected from 48 patients diagnosed of 
urothelial bladder cancer. Patients were followed-up through the hospital 
pathological charts to identify whether and when the disease recurred or 
progressed. Subsequently, they were classified according to whether or not they 
suffered a tumour recurrence (recurrent or stable) as well as their risk group 
according to tumour grade and stage. Identified metabolites have been analysed 
in terms of disease characteristics (tumour stage and recurrence) and have 
provided an insight into bladder cancer progression. Using both liquid 
chromatography and capillary electrophoresis-mass spectrometry, a total of 27 
metabolite features were highlighted as significantly different between patient 
groups. Some, for example histidine, phenylalanine, tyrosine and tryptophan have 
been previously linked with bladder cancer, however until now their connection 
with bladder cancer progression has not been previously reported. The candidate 
biomarkers revealed in this study could be useful in the clinic for diagnosis of 
bladder cancer and, through characterising the stage of the disease, could also 
be useful in prognostics.