Of the most important clinical needs for bladder cancer (BC) management is the identification of biomarkers for disease aggressiveness. Urine is a "gold mine" for biomarker discovery, nevertheless, with multiple proteins being in low amounts, urine proteomics becomes challenging. In the present study we applied a fractionation strategy of urinary proteins based on the use of immobilized metal affinity chromatography for the discovery of biomarkers for aggressive BC. Urine samples from patients with non invasive (two pools) and invasive (two pools) BC were subjected to immobilized metal affinity chromatography fractionation and eluted Bladder cancer (BC) 1 is the second in incidence and mortality cancer of the genitourinary system (1) and estimated to be the ninth most common malignancy (2). It is associated with a high recurrence rate underscoring the need for continuous surveillance following initial treatment. Cystoscopy still remains the gold standard for diagnosis and follow-up monitoring of bladder cancer. However, it is an invasive and unpleasant procedure, rendering particularly the regular surveillance program (e.g. cystoscopy every three months for the first year following initial diagnosis) not well accepted by the patients (3, 4). Urine Cytology is a noninvasive current detection tool for BC, suffering however from suboptimal sensitivity, especially for low grade tumors and being subjected to interobserver variability (5). The invasive nature of cystoscopy and the low effectiveness of cytology have prompted the search for novel and better ways to diagnose the disease with special emphasis on the early detection of disease recurrences and/or progression.Urine is regularly used in clinical practice and yields a wealth of information about the state of an individual's health. Because it can be collected in a noninvasive way it is more accessible than plasma or serum. In addition, there is no need for trained personnel for urine collection. Urine contains cells and cellular debris, inorganic ions (K ϩ , Na ϩ , Cl Ϫ , and Ca ϩ2 ), organic molecules (urea, uric acid, and creatinine) and proteins. If renal function is normal, urinary protein content is less