(UroToday.com) The 2026 European Association of Urology (EAU) annual meeting featured a late-breaking abstracts session and a presentation by Dr. Peter J. Bostrom discussing results from the FinnBladder 9 trial assessing fluorescence cystoscopy and adjuvant optimized mitomycin-C in non-muscle invasive bladder cancer with high risk of recurrence. Intermediate risk non-muscle invasive bladder cancer has low progression risk, but especially large (>3cm), multiple, and recurring tumors have high recurrence risk.
Recurrence risk may be decreased with a single immediate postoperative chemotherapy instillation and adjuvant therapies. The EAU guidelines recommend either BCG or intravesical chemotherapy for 1 year. Mitomycin-C chemotherapy effect may be improved with optimization (dehydration, alkalinization, increased drug concentration), and fluorescence/blue light cystoscopy is suggested to enhance drug efficacy. As such, Dr. Bostrom and colleagues investigated the role of fluorescence cystoscopy and a short course of adjuvant optimized mitomycin-C in low-grade non-muscle invasive bladder cancer with high recurrence risk.
FinnBladder 9 randomly assigned subjects with pTa low non-muscle invasive bladder cancer in high risk of recurrence in a 1:1:1:1 ratio to:
- Arm A: White light TURBT without adjuvant therapy
- Arm B: Blue light TURBT without adjuvant therapy
- Arm C: White light TUR-BT with six weekly optimized mitomycin-C
- Arm D: Blue light TURBT with six weekly optimized mitomycin-C
Randomization was performed before TURBT and stratified according to center and history of recurrences. The primary outcome was recurrence, and the sample size estimation was based on a hypothesis of 15% risk reduction for both blue light (versus white light) and for adjuvant optimized mitomycin-C (versus no adjuvant therapy). The secondary endpoints included progression, survival, and cost-effectiveness.
Between December 2012 and April 2022, a total of 510 subjects were randomized in 9 centers in Finland, of which 257 were eligible, and 253 were ineligible. The median age was 72 years (IQR 67-78), 56% had primary tumors, 43% of the tumors were multiple, and 15% were >3cm:
The median follow-up was 5.2 years, and the recurrence risk in the entire study was 35%. Compared to white light only (study arm A), subjects receiving blue light TURBT followed with adjuvant mitomycin-C (arm D) had significantly fewer recurrences, HR 0.42 (95%CI 0.22-0.81, p = 0.010):
No differences in recurrence between other arms could be detected. The progression risk was very low in the entire study cohort (1.6%) with no differences between study arms.
Dr. Bostrom concluded his presentation discussing results from the FinnBladder 9 trial with the following take-home points:
- The FinnBladder-9 study demonstrates that in subjects with non-muscle invasive bladder cancer with high risk of recurrence, a combination of blue-light TURBT followed by six weekly optimized mitomycin-C reduced the risk of recurrences
- PDD and adjuvant mitomycin-C resulted in a hazard ratio of 0.43 (95% CI 0.22-0.83, p = 0.01) when compared to white light and no adjuvant instillations
- There were no significant differences between the other study arms
Presented by: Peter J. Bostrom, MD, PhD, Turku University Hospital, Turku, Finland
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2026 European Association of Urology (EAU) Annual Meeting, London, United Kingdom, Fri, Mar 13 – Mon, Mar 16, 2026.