Photodynamic diagnosis in patients with T1G3 bladder cancer: influence on recurrence rate

• Published in: World journal of urology Vol. 28; no. 4; pp. 407 - 411
• Main Authors: Stanislaus, Peter, Zaak, Dirk, Stadler, Thomas, Tritschler, Stefan, Knüchel, Ruth, Stief, Christian G., Karl, Alexander
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-08-2010; Springer; Springer Nature B.V
• Subjects: Aged; Aminolevulinic Acid - analogs & derivatives; Biological and medical sciences; Bladder cancer; Carcinoma in Situ - diagnosis; Carcinoma in Situ - epidemiology; Cystoscopy - methods; Cystoscopy - statistics & numerical data; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - epidemiology; Nephrology; Nephrology. Urinary tract diseases; Oncology; Original Article; Photosensitizing Agents; Prognosis; Retrospective Studies; Tumors of the urinary system; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - epidemiology; Urinary Bladder Neoplasms - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; Fluorescence endoscopy; PDD; Influence; T1G3 bladder cancer; Recurrence rate; Human; Nephrology; Relapse; Urinary system disease; Rate; Fluorescence; Urinary tract disease; Malignant tumor; Bladder cancer; Urology; Photodynamic diagnosis; Bladder disease; Endoscopy; Cancer
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-010-0574-y

Introduction
Therapeutic strategies on treatment of T1G3 urothelial cancer of the urinary bladder are controversial. The objective of this study was to investigate the impact of photodynamic diagnosis (PDD) on the recurrence-free survival rate of patients with the initial diagnosis of T1G3 bladder cancer.
Patients and methods
Between 1995 and 2007, 153 patients were treated for T1G3 bladder cancer at our institution. In 77 patients, initial TUR-BT was performed under PDD condition at our hospital, and 76 patients underwent TUR-BT in a standard white light setting at other institutions. PDD was performed either using 5-aminolevulinate or hexaminolevulinate for induction of fluorescence. Average follow-up was 53.9 months. Fisher’s exact test and Kaplan–Meier method were used to test data for significance.
Results
Of the 77 patients who were treated using PDD at initial TUR-BT, recurrence was observed in 23 (29.9%) cases, whereas 43 of 76 (56.6%) patients treated without PDD showed recurrence (
P
 < 0.001). The detection rate of additional carcinoma in situ was 35.4% in the PDD group versus 21.8% in the white light group (
P
 = 0.077). A limitation of the present study is the retrospective, monocentre setting, which is more likely to be biased.
Conclusion
PDD during initial TUR-BT in T1G3 bladder cancer seems to reduce significantly the rate of recurrence in our study population. Therefore, PDD seems to be associated with superior initial tumour control and more effective tumour treatment even in patients with highly aggressive tumours like T1G3 bladder cancer.