“Blue light” photodynamic diagnosis (PDD) of nonmuscle-invasive bladder cancer (NMIBC) reduces the risk of disease recurrence after surgery compared with a diagnosis made using white light cystoscopy, investigators reported during the 36th annual European Association of Urology virtual congress.
Investigators from The Newcastle upon Tyne Hospitals NHS Foundation Trust in the United Kingdom conducted an updated systematic review and meta-analysis of the effect of PDD vs white light (WL) cystoscopy on disease recurrence following transurethral resection of bladder tumor (TURBT) using data on 2288 patients from 12 randomized trials published up to April 2020.
PDD TURBT significantly reduced the risk of NMIBC recurrence by 27% at 12 months and 25% at 24 months relative to WL TURBT, Paul Gravestock, MD, reported. Conversely, hazard ratios showed that WL TURBT significantly increased the risk of recurrence by 14% at 12 months and 25% at 24 months compared with PDD TURBT. Two studies reported longer-term data. The first study reported lower recurrence rates at 60 months for PDD: 49% PDD vs 68% WL. In the second study, recurrence-free survival at 60 months was higher with PDD: 68% PDD vs 57% WL.
No significant adverse effects with PDD were found in the 5 studies that included the information, Dr Gravestock reported. Additional safety data is needed.
Dr Gravestock pointed out significant heterogeneity existed between trials. In 6 studies, patients received a single dose of intravesical chemotherapy immediately after TURBT. The remaining 6 studies did not use postoperative chemotherapy but allowed unspecified adjuvant therapy based on tumor risk. Tumor demographics also varied, which is relevant because PDD TURBT is believed to be most effective for high-risk and multifocal disease, he noted. GRADE analysis showed the overall evidence was moderate quality, but the risk for bias was unclear.
As he concluded his presentation, Dr Gravestock highlighted that PDD TURBT has a learning curve. Its real-world utility is currently unclear. Before PDD TURBT can be adopted into clinical practice, long-term data and a large pragmatic trial are needed.
Gravestock P, Veeratterapillay R, Nambiar A, et al. Time to turn on the blue lights: A systematic review and meta-analysis of photodynamic diagnosis for bladder cancer. Presented at the EAU 2021 virtual congress, July 8-12, 2021. Abstract P0717.