Compared with normal epithelial cells, RNA and protein expression of cyclooxygenase-2 (COX-2) and urinary prostaglandin E2 is increased in urothelial carcinoma, suggesting upregulation of the COX-2 pathway during cancer progression.47,48,49,50 Similarly, elevated expression of COX-2 in breast cancer has been shown to be a predictor of disease outcome (eg, progression, decreased survival).51,52 This may be partly due to the mechanistic interplay between angiogenesis, cell proliferation, apoptosis, and inflammatory processes.53 This evidence concerns the gene PTGS2 and urothelial carcinoma.