PTGS2 and cancer: 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