Blue Light Flexible Cystoscopy with Hexaminolevulinate in Non- Muscle-Invasive Bladder Cancer: Review of the Clinical Evidence and Consensus Statement on Optimal Use in the USA — Update 2018

Blue light cystoscopy (BLC) with hexaminolevulinate (HAL) during transurethral resection of bladder cancer improves detection of non- muscle-invasive bladder cancer (NMIBC) and reduces recurrence rates. Flexible BLC was approved by the FDA in 2018 for use in the surveillance setting and was demonstrated to improve detection. Results of a phase III prospective multicentre study of blue light flexible cystoscopy (BLFC) in surveillance of intermediate- risk and high- risk NMIBC showed that 20.6% of malignancies were identified only by BLFC. Improved detection rates in the surveillance setting are anticipated to lead to improved clinical outcomes by reducing future recurrences and earlier identification of tumors that are unresponsive to therapy. Thus, BLFC has a role in surveillance cystoscopy and determining which patients will benefit from BLFC and optimal and cost- effective ways of incorporating this technology into surveillance cystoscopy must be developed.

Yair Lotan 1*, Trinity J. Bivalacqua2, Tracy Downs3, William Huang4, Jeffrey Jones 5, Ashish M. Kamat6, Badrinath Konety7, Per- Uno Malmström8, James McKiernan9, Michael O’Donnell10, Sanjay Patel11, Kamal Pohar12, Matthew Resnick13, Alexander Sankin14, Angela Smith15, Gary Steinberg16, Edouard Trabulsi17, Michael Woods18 and Siamak Daneshmand19

1. UT Southwestern Medical Center, Dallas, TX, USA
2. James Buchanan Brady urological institute, Johns Hopkins University, Baltimore, MD, USA
3. Department of Urology, University of Wisconsin, Madison, WI, USA
4. Department of Urology, New York University School of Medicine, New York, NY, USA
5. Genitourinary surgery section, Michael e. DeBakey VA Medical Center, Houston, TX, USA
6. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
7. Department of Urology, University of Minnesota, Minneapolis, MN, USA
8. Department of Urology, Institute of surgical sciences, Uppsala University, Uppsala, Sweden.
9. Department of Urology, Columbia University Medical Center, New York City, NY, USA
10. Department of Urology, University of Iowa, Iowa City, IA, USA
11. Department of Urology, University of Oklahoma, Oklahoma City, OK, USA
12. Department of Urology, Ohio state university, Columbus, OH, USA.
13. Department of urologic surgery, Vanderbilt University, Nashville, TX, USA
14. Department of Urology, Montefiore Medical Center, New York, NY, USA
15. Department of Urology, University of North Carolina, Chapel Hill, NC, USA
16. Department of Urology, University of Chicago, Chicago, IL, USA
17. Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University,
Philadelphia, PA, USA
18. Department of Urology, Loyola University Chicago, Chicago, IL, USA
19. Department of Urology, University of Southern California, Los Angeles, CA, USA

Lotan, Y., Bivalacqua, T., Downs, T., Huang, W., Jones, J., Kamat, A., Konety, B., Malmström, P., McKiernan, J., O’Donnell, M., Patel, S., Pohar, K., Resnick, M., Sankin, A., Smith, A., Steinberg, G., Trabulsi, E., Woods, M. and Daneshmand, S. (2019). Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA — update 2018. Nature Reviews Urology.
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