SUO 2022: The Impact of Blue Light Cystoscopy on Tumor Recurrence in Non-Muscle Invasive Bladder Cancer Patients Treated in a Real-World Setting

( The 2022 Society of Urologic Oncology (SUO) annual meeting featured a session on bladder cancer, including a presentation by Dr. Sia Daneshmand discussing the impact of blue light cystoscopy on tumor recurrence in non-muscle invasive bladder cancer patients treated in a real-world setting. Patients with non-muscle-invasive bladder cancer suffer high recurrence rates that may lead to greater disease progression and worse overall clinical outcomes. White light cystoscopy is the standard of care for monitoring non-muscle-invasive bladder cancer, though there is substantial evidence that enhanced detection methods such as blue light cystoscopy can find further tumors missed by white light alone. Dr. Daneshmand and colleagues reported the impact of blue light cystoscopy use on recurrence rates among non-muscle-invasive bladder cancer patients in a real-world clinical care setting.

The US Blue Light Cystoscopy with Cysview® Registry (Clinical Trials: NCT02660645) is a large prospective, longitudinal, real-world evidence study in non-muscle-invasive bladder cancer patients who have undergone transurethral resection of the bladder (TURBT) using blue light as an adjunct to white light cystoscopy. The data represents an interim analysis of the study, which is projected to enroll 4,400 patients in total. All registry patients analyzed (n = 2,055) received blue light cystoscopy and they were directly compared to a historical white-light only control group (n = 261) of similar age, stage, grade and clinical management (i.e., intravesical therapy). By way of context, as follows are representative images of non-muscle invasive bladder cancer lesions that were missed on white light cystoscopy that demonstrate fluorescence on blue light evaluation:
The Kaplan-Maier graph showed recurrence free survival (RFS) curves for the blue light cystoscopy patients within the Cysview Registry against a white light only arm. Mean follow-up in the blue light cystoscopy registry study was 27.4 months (26-78 months) and 53 months (37-71 months) for the white light historical control arm. The overall risk of recurrence was significantly lower following blue light cystoscopy compared to white light cystoscopy alone (HR 0.33; 95% CI 0.28-0.40, p-value < 0.0001):line graph.jpg
Incidence of lower recurrence in the blue light cystoscopy arm were durable, as rates tracked over 5-years consistently out-performed white light cystoscopy. 

Dr. Daneshmand concluded his presentation by discussing the impact of blue light cystoscopy on tumor recurrence in non-muscle invasive bladder cancer patients treated in a real-world setting with the following take home messages:

  • In a large, multisite registry study, evidence supports the use of blue light cystoscopy, in combination with conventional white light cystoscopy, significantly decreasing the risk of recurrence and prolonged time interval to recurrence
  • The results indicate that better tumor detection through enhanced cystoscopy has the potential to translate to more favorable long-term outcomes in a real-world setting

Presented by: Sia Daneshmand, MD, University of Southern California, Los Angeles, CA

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 Society of Urologic Oncology (SUO) Annual Meeting, San Diego, CA, Wed, Nov 30 – Fri, Dec 2, 2022.