SIU 2017: Controversies in Urology--Bladder Cancer: Old is Gold!

Lisbon, Portugal ( Dr. Risk presented his support for the old traditional white light cystoscopy. Dr. Risk began with stating that there is a need for randomized controlled trials (RCT) to demonstrate a true advantage and improvement in outcomes with the usage of fluorescent cystoscopy (FC), compared to white cystoscopy. So far, the level of evidence for this has been low, with heterogeneity and inconsistency very common. There has also been proof for performance bias, detection bias, and publication bias. 

Furthermore, so far there has been no benefit shown for FC in terms of progression or mortality on a number of meta-analyses. Additionally, data is lacking regarding the safety in repeated use of FC, and cost analysis must be done as well, to assess its financial impact.

Narrow band imaging, similar to FC, can supposedly find more tumors and has been shown to decrease recurrence in non RCT trials.

Dr. Risk concluded his talk stating that currently we know that a variety of techniques can improve diagnostic sensitivity and specificity over white light cystoscopy. There is some evidence that FC can reduce recurrence rates. What we eventually need today, according to Dr. risk, is proof of cost benefit, advantage in progression rates, lower need for cystectomy, and higher survival. Lastly, we need more data regarding safety of FC. Thoughtful construction of a randomized controlled trial to account for various potential biases must be performed to get more answers.

Presented by: Michael Risk

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal
email news signup