SUO 2017: Flexible Blue Light Cystoscopy with Hexaminolevulinate (HAL) in the Surveillance of Bladder Cancer

Washington, DC ( There is a high recurrence rate of non-muscle invasive bladder cancer (NMIBC) following TURBT. Blue light with Cysview (BLCC) is more sensitive than white light cystoscopy (WLC) detecting both papillary tumors and CIS. Dr. Daneshmand gave an excellent talk on the results of the study demonstrating use of blue light flexible cystoscopy in the detection of bladder cancer during surveillance. This was a prospective, multicenter open phase 3 patient controlled trial including 304 patients with NMIBC examined with BLCC. The study aimed to determine improved bladder cancer detection. 17 US sites participated and 2 study procedures were performed – surveillance with BLCC and then a TURBT surgery was performed when suspicion of recurrence had arose.

Out of the 304 patients included, 117 had no malignancy, and 103 were taken to the operating room for a biopsy (TURBT). Of these, 63 were confirmed to have malignancy on the biopsy. The mean exposure time of the HAL was 88 minutes. The proportion of tumors detected by only the blue light was 21% (<0.001). In addition, nine of 26 CIS tumors (34.6%) were exclusively seen with blue light flexible cystoscopy. There was no indication that the repeat blue light cystoscopy with Cysview had any morbidity. Furthermore, 46% had additional tumors discovered only with the BLCC. 9.1% of the patients had false positive seen only with BLCC and 9.1% had false positive seen only with WLC. In addition, patient reported outcomes were also investigated, 90% of patients felt it was worthwhile to undergo Cysview, would do the procedure again, and would recommend the procedure to others.

BLCC significantly improves the detection of recurrent bladder cancer (20.6%), CIS (34.6%), and improved tumor detection (46%). Repeat use of BLCC was reported as safe procedure. Lastly, patients found it worthwhile to undergo BLCC and would recommend it to others. Dr. Daneshmand concluded his talk suggesting that BLCC be used in patients in surveillance of their bladder cancer recurrence and for management in the OR.

Presented by: Siamak Daneshmand, University of Southern California, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC