Early PDD Cystoscopy after BCG Induction for High-risk Non-Muscle Invasive Bladder Cancer Significantly Increased the Detection of BCG-refractory Tumors.

To compare the detection rate of BCG refractory tumors between white light cystoscopy (WL-C) and Photodynamic Diagnosis cystoscopy (PDD-C).

We performed a monocentric retrospective study that included all consecutive patients with high-risk non-muscle-invasive bladder cancer (NMIBC) diagnosed from January 2017 to January 2021.

All patients had an initial Transurethral resection of bladder tumor (TURBT) with PDD ± restaging TURBT if needed, followed by full-dose BCG induction. Within 8 weeks following BCG induction all patients had both WL-C and PDD-C under general anesthesia ± TURBT in case of suspicious lesion. The primary endpoint was the detection of bladder cancer (BC) at post-BCG cystoscopy.

A total of 136 consecutive patients met inclusion criteria. Initial BC characteristics were: 35.6% of T1 tumor, 92.6% high-grade and 48.6% associated cis. BC was diagnosed in 33/136 cases (24%) at early PDD-C after BCG induction: 77% Ta, 23% T1, 56% associated cis, 68% high grade and 6% MIBC. Sensibility and Specificity of WL-C and PDD-C: 41 vs 91% (p<0.001) and 86 vs 75% (p=0.001). PDD-C detected 16 additional tumors: 81.3% Ta, 18.7% T1, 75% associated cis and 75% high grade.

Systematic use of PDD after BCG induction increased the detection of BCG-refractory tumors and lead to significant modification in the treatment of high-risk NMIBC. Future studies are needed to evaluate long-term oncological benefit of early PDD reevaluation and its cost-effectiveness.

Journal of endourology. 2021 Jun 09 [Epub ahead of print]

Michele Morelli, Michael Baboudjian, Davide Vanacore, Bastien Gondran-Tellier, Robin McManus, Gilles Karsenty, Eric Lechavallier, Emanuele Montanari, Romain Boissier

Aix-Marseille-University, 128791, Urology, Marseille, Provence-Alpes-Côte d'Azur, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, 147 bd baille, Marseille, France, 13005., Aix-Marseille-University, 128791, Urology, Marseille, Provence-Alpes-Côte d'Azur, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Marseille, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Conception Academic Hospital, Aix Marseille University, Marseille, Marseille, France, France; ., Assistance Publique Hopitaux de Marseille, 36900, Urologie, Marseille, Provence-Alpes-Côte d'Azu, France; ., hopital La Conception, Urologie, 147 bd Baille, Marseille, France, 13385; ., IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Urology, via della Commenda 15, Milan, Italy, 20122; ., Aix-Marseille-University, 128791, Urology, Marseille, Provence-Alpes-Côte d'Azur, France; .

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