Introduction: Bladder carcinoma is the most common male cancer in our environment due to endemicity of schistosomiasis. Squamous-cell carcinoma is the most common histological type and patients present at an advanced stage. The objective of this study is to compare the sensitivity, specificity, and predictive values of the bladder tumor antigen quantitative test (BTA TRAK) and urine cytology in the diagnosis of bladder carcinoma in a schistosoma endemic area. Materials and Methods: This is a 12-month cross-sectional study of 88 patients, 52 of them with features of bladder carcinoma as study group, and 36 of them with hematuria from other urologic conditions, and benign urologic conditions and healthy volunteers as control group (CG). The mean ages of patients in the study and CGs were 47.17 ± 17.00 and 44.19 ± 18.89 years, respectively ( P = 0.412). Bladder tumor antigen was assayed using enzyme-linked immunosorbent assay. Data were analyzed using SPSS version 20.0 for Windows. Results: The sensitivity of urine cytology and BTA TRAK in the study was 29.1% and 98.8%, respectively. The specificity of urine cytology and BTA TRAK was 95.5% and 13.6%, respectively ( P = 0.05). The positive predictive values of urine cytology and BTA TRAK in the study were 96.2% and 81.7%, respectively. The negative predictive values were 25.0% and 75.0% for urine cytology and BTA TRAK, respectively. Conclusion: BTA TRAK is more sensitive but poorly specific as compared to that of the urine cytology for bladder cell carcinoma detection in a schistosoma endemic area.