Additional oncological benefit of photodynamic diagnosis with blue light cystoscopy in transurethral resection for primary non‐muscle‐invasive bladder cancer: A comparative study from experienced institutes

Miyake, Makito; Nishimura, Nobutaka; Nakahama, Tomonori; Nishimoto, Katsutaro; Oyama, Masafumi; Matsushita, Yuto; Fukuhara, Hideo; Inoue, Keiji; Kobayashi, Keita; Matsumoto, Hiroaki; Matsuyama, Hideyasu; Fujii, Tomomi; Hirao, Yoshihiko; Fujimoto, Kiyohide

doi:10.1002/bco2.215

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…Moreover, in a study of 1578 consecutive patients with primary NMIBC, Miyake et al revealed that PDD-TURBT decreased the risk of high-and low-grade tumor recurrences compared with WL-TURBT. PDD significantly reduced the risk of International Bladder Cancer Group-defined progression in patients with NMIBC [106]. However, PDD-TURBT did not reduce recurrence in patients with NMIBC of ≥30 mm [106,107].…”

Section: Pdd With 5-ala For Turbt In Nmibcsmentioning

confidence: 89%

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Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

Kurabayashi,

Fukuhara,

Furihata

et al. 2024

Cancers

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Bladder cancer (BC) possesses distinct molecular profiles that influence progression depending on its biological nature and delivered treatment intensity. Muscle-invasive BC (MIBC) and non-MIBC (NMIBC) demonstrate great intrinsic heterogeneity regarding different prognoses, survival, progression, and treatment outcomes. Transurethral resection of bladder tumor (TURBT) is the standard of care in treating NMIBC and serves both diagnostic and therapeutic purposes despite the prevalent recurrence and progression among many patients. In particular, flat urothelial carcinoma in situ and urothelial carcinoma with lamina propria invasion are the major precursors of MIBC. A new-generation photosensitizer, 5-Aminolevulinic acid (5-ALA), demonstrates high tumor specificity by illuminating the tumor lesion with a specific wavelength of light to produce fluorescence and has been studied for photodynamic diagnosis to detect precise tumor areas by TURBT. Additionally, it has been applied for treatment by producing its cytotoxic reactive oxygen species, as well as screening for urological carcinomas by excreting porphyrin in the blood and urine. Moreover, 5-ALA may contribute to screening before and after TURBT in NMIBC. Here, we summarize the updated evidence and ongoing research on photodynamic technology for NMIBC, providing insight into the potential for improving patient outcomes.

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Section: Pdd With 5-ala For Turbt In Nmibcsmentioning

confidence: 89%

“…PDD significantly reduced the risk of International Bladder Cancer Group-defined progression in patients with NMIBC [106]. However, PDD-TURBT did not reduce recurrence in patients with NMIBC of ≥30 mm [106,107]. The 5-ALA-induced stability of PpIX is dependent on the wavelength and intensity of the right side.…”

Section: Pdd With 5-ala For Turbt In Nmibcsmentioning

confidence: 95%

Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

Kurabayashi,

Fukuhara,

Furihata

et al. 2024

Cancers

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“…Photodynamic diagnosis (PDD) and narrow‐band imaging (NBI) are the most widely used macroscopic image‐enhancement modalities. PDD requires special blue light cystoscopy systems and intravesical instillation of drugs, including 5‐aminolevulinic acid (ALA) 24–29 and hexaminolevulinate 30–36 or oral administration of ALA 37–42 . The basic principle in PDD underlies the selective accumulation of protoporphyrin IX and emission of red fluorescence in cancer cells when excited by blue light, enabling discrimination between non‐cancer lesions and cancer lesions 43 .…”

Section: Advancements In Surgical Concepts Techniques and Devices For...mentioning

confidence: 99%

“…Two studies demonstrated that the risk of IBCG‐defined progression was decreased by PDD use in NMIBC patients (Figure 1c). 37,49 According to our previous study with one‐to‐one propensity score matching comparison between PDD‐TURBT versus WL‐TURBT ( n = 495, each), the PDD use decreased the risks of intravesical recurrence ( p = 0.02), IBCG‐defined progression ( p = 0.044), grade‐up ( p = 0.037), HG‐intravesical recurrence ( p = 0.017); no difference was noted in conventional progression ( p = 0.82), development of muscle‐invasive disease ( p = 0.86), and metastasis ( p = 0.072). However, real‐world evidence regarding the benefits of using a PDD based on the IBCG‐defined definition is scarce.…”

Section: Advancements In Surgical Concepts Techniques and Devices For...mentioning

confidence: 99%

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, andBCG‐treated disease

et al. 2023

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In the management of non‐muscle invasive bladder cancer (NMIBC), disease progression and long‐term control are determined by the intensity of delivered treatment and surveillance and the cancer cells' biological nature. This requires risk stratification–based postoperative management, such as intravesical instillation of chemotherapy drugs, Bacillus Calmette–Guérin (BCG), and radical cystectomy. Advancements in mechanical engineering, molecular biology, and surgical skills have evolved the clinical management of NMIBC. In this review, we describe the updated evidence and perspectives regarding the following aspects: (1) advancements in surgical concepts, techniques, and devices for transurethral resection of the bladder tumor; (2) advancements in risk stratification tools for NMIBC; and (3) advancements in treatment strategies for BCG‐treated NMIBC. Repeat transurethral resection, en‐bloc transurethral resection, and enhanced tumor visualization, including photodynamic diagnosis and narrow‐band imaging, help reduce residual cancer cells, provide accurate diagnosis and staging, and sensitive detection, which are the first essential steps for cancer cure. Risk stratification should always be updated and improved because the treatment strategy changes over time. The BCG‐treated disease concept has recently diversified to include BCG failure, resistance, refractory, unresponsiveness, exposure, and intolerance. A BCG‐unresponsive disease is an extremely aggressive subset unlikely to respond to a rechallenge with BCG. Numerous ongoing clinical trials aim to develop a future bladder‐sparing approach for very high‐risk BCG‐naïve NMIBC and BCG‐unresponsive NMIBC. The key to improving the quality of patient care lies in the continuous efforts to overcome the clinical limitations of bedside management.

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“…Given the substantial heterogeneity in NMIBC, the risks of recurrence, progression, and death vary among patients with varying disease risks. Of note, patients with high‐risk NMIBC are associated with a 30%–40% risk of bladder cancer recurrence and 15%–25% of cancer progression during a 5‐year follow‐up from the initial diagnosis 1,2 …”

Section: Introductionmentioning

confidence: 99%

Differences in oncological benefits from second transurethral resection between white‐light initial surgery and photodynamic diagnosis‐guided initial surgery for primary high‐risk non‐muscle invasive bladder cancer

Miyake,

Nishimura,

Nakahama

et al. 2024

Int J of Urology

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ObjectivesThe aim of this study was to compare clinical outcomes between patients receiving second TUR after initial white‐light transurethral resection of bladder tumor (WL‐TURBT) and initial photodynamic diagnosis (PDD)‐assisted TURBT.MethodsA total of 1007 patients were divided into four groups based on the treatment pattern: WL‐TURBT with second TUR (161 patients, WL‐second group) or without second TUR (540 patients, WL‐alone group) and PDD‐TURBT with second TUR (112 patients, PDD‐second group) or without second TUR (194 patients, PDD‐alone group). Oncologic outcomes (bladder cancer recurrence, progression, urothelial cancer‐specific mortality) and rates of residual tumor and risk stratification of non‐muscle‐invasive bladder cancer (NMIBC) after second TUR were evaluated.ResultsAfter propensity score‐matching 121 patients were included each in the WL‐alone and WL‐second groups, and 63 patients each in the PDD‐alone and PDD‐second groups. In the WL group, the second TUR was significantly associated with improved progression‐free (p = 0.012) and urothelial cancer‐specific free survival (p = 0.011), but not with recurrence‐free survival (p = 0.93). Patients initially treated with PDD‐TURBT, and with a tumor diameter <30 mm and multifocality had a relatively high benefit from second TUR. The rates of residual tumor and risk stratification of NMIBC did not significantly differ between WL‐TURBT and PDD‐TURBT groups.ConclusionsOur findings suggested that a second TUR could be omitted after an initial PDD‐TURBT in selected patients with high‐risk NMIBC.

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Additional oncological benefit of photodynamic diagnosis with blue light cystoscopy in transurethral resection for primary non‐muscle‐invasive bladder cancer: A comparative study from experienced institutes

Cited by 9 publications

References 25 publications

Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, andBCG‐treated disease

Differences in oncological benefits from second transurethral resection between white‐light initial surgery and photodynamic diagnosis‐guided initial surgery for primary high‐risk non‐muscle invasive bladder cancer

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