Compared with standard white light cystoscopy, photodynamic diagnosis (PDD) cystoscopy with 5-aminolaevulinic acid better detects malignant bladder cancer that is refractory to intravesical bacillus Calmette-Guerin (BCG), investigators reported at the 36th annual European Association of Urology virtual congress.
Michele Morelli, MD, of Aix-Marseille-University in France and colleagues studied 136 patients with high-risk nonmuscle-invasive bladder cancer (NMIBC) at their center. Median age was 73 years, and 84% were male. All patients had transurethral resection of bladder tumor (TURBT) with PDD. At the time of TURBT, 65.5% and 35.6% of patients had stage Ta and T1 tumors, respectively, 92.6% had high-grade tumors, and 48.6% had carcinoma in situ (cis). Half of the patients had multiple tumors, and 26.5% had a tumor diameter of 3 cm or longer.
All patients received 6 weeks of full-dose BCG induction after TURBT. Within 40 days of the last BCG induction, patients had both white light cystoscopy and photodynamic diagnosis cystoscopy.
PDD detected bladder cancer in 32 cases (24%), including 77% Ta, 23% T1, 56% cis, and 68% high grade. White light cystoscopy detected 13 BCG-refractory tumors, but PDD detected 14 additional tumors, Dr Morelli reported. Management changed for some patients, including new BCG induction in 13 patients and 1 radical cystectomy.
Systematic use of PDD after BCG induction increased detection of BCG-refractory tumors from 10% to 21% and led to significant modification in the treatment of high-risk NMIBC, Dr Morelli concluded. White light cystoscopy displayed significantly lower sensitivity than photodynamic diagnosis cystoscopy (41% vs 91%), although it had significantly higher specificity (86% vs 75%).
The oncologic benefit of this higher diagnosis of BCG-refractory NMIBC and the cost of systematic use of photodynamic diagnosis cystoscopy still need to be evaluated, he noted.
Morelli M, Baboudjian M, Boissier R, et al. Early PDD cystoscopy after BCG induction for high-risk non-muscle invasive bladder cancer significantly increased the detection of BCG-refractory tumors. Presented at the EAU 2021 virtual conference, July 8-12, 2021. Abstract P0716.