SUO 2023: Comparing White Light versus Blue Light Cystoscopy Recurrence Outcomes Among Non-Muscle Invasive Bladder Cancer Patients in an Equal Access Setting: A Propensity-scored Matched Analysis

( The 2023 Society of Urologic Oncology (SUO) annual meeting held in Washington, D.C. between November 28th and December 1st, 2023, was host to a poster/abstract session. Dr. Sanjay Das presented the results of a propensity-scored matched analysis comparing white light versus blue light cystoscopy recurrence outcomes among non-muscle invasive bladder cancer (NMIBC) patients within the context of an equal access setting.

There has been recent conflicting evidence regarding the utility of blue light cystoscopy and its impact on oncologic outcomes. In this report, Dr. Das and colleagues aimed to describe the recurrence outcomes among a predominantly high-risk NIMBC patient cohort that underwent blue light versus white light cystoscopy in an equal access health care setting.

The authors performed a retrospective cohort study of NMIBC patients treated within the Veterans Affairs (VA) health care system who underwent either a blue light or white light cystoscopy between January 1, 1991, and January 31, 2023. A total of 337 blue light cystoscopy recipients were first identified and then compared to 337 white light cystoscopy recipients using 1:1 propensity score matching. The variables used to calculate the propensity score between the cohorts included:

  • Age at diagnosis
  • Gender
  • Race/ethnicity
  • Location of bladder cancer diagnosed (within a VA facility versus outside VA)
  • Smoking status
  • Clinical grade group
  • BCG treatment (yes/no)

Time to recurrence following either blue light or white light cystoscopy was calculated from the date of bladder cancer diagnosis. Survival analysis using the Kaplan-Meier method was used to estimate event-free survival, and Cox regression modeling was used to evaluate the association between cystoscopic modality (blue versus white light) and recurrence rates.

The authors included a total of 674 patients in the matched analysis (337 blue light and 337 white light cystoscopy patients). The median follow-up was 3.4 and 2 years in the blue and white light cystoscopy groups, respectively. The median patient age at diagnosis was 71 – 72 years. 99% were male and 11% were black, consistent with the VA patient demographics. 61% and 55% of patients in the blue and white light cystoscopy groups received BCG. 9-11% of patients had CIS +/- papillary disease, and 54% had HG Ta/T1 disease +/- CIS.


On multivariable analysis, the rate of recurrence was significantly lower following blue light cystoscopy (HR: 0.67; 95% CI: 0.51 to 0.89, p=0.006).



Dr. Das concluded that there is a significantly decreased rate of recurrence in NMIBC patients who receive blue light versus white light cystoscopy when treated in the context of the equal access VA health care setting. 

Presented by: Sanjay Das, MD, Postdoctoral Research Fellow, Department of Urology, University of California, Los Angeles, CA

Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 Society of Urologic Oncology (SUO) Annual Meeting, Washington, D.C., Tues, Nov 28 – Fri, Dec 1, 2023.