5-aminolaevulinic acid-induced fluorescence cystoscopy during transurethral resection reduces the risk of recurrence in stage Ta/T1 bladder cancer.
OBJECTIVE
To assess the influence of 5-aminolaevulinic acid-induced fluorescence cystoscopy (FC) during transurethral resection (TUR) on the recurrence rate and the length of tumour-free interval in stage Ta/T1 transitional cell carcinoma (TCC) of the urinary bladder.


METHODS
In all, 122 patients with primary or recurrent stage Ta/T1 bladder TCC treated with TUR were enrolled in a prospective randomized study. In group A the TUR was performed with standard white-light endoscopy, and in group B with FC. The patients were followed using standard cystoscopy and urinary cytology. The recurrence-free interval was evaluated in whole groups, for single and multiple, and for primary and recurrent tumours separately.


RESULTS
At the time of the first cystoscopy (10-15 weeks after TUR) tumour recurrence was detected in 23 of 62 patients (37%) in group A, but only in five of 60 patients (8%) in group B. The recurrence-free survival rates in group A were 39% and 28% after 12 and 24 months, compared to 66% and 40% respectively in group B (P = 0.008, log-rank test). In separate analyses, the recurrence-free survival rates were significantly higher using FC in multiple (P = 0.001) and in recurrent (P = 0.02) tumours. In solitary and primary tumours the median time to recurrence was also longer in group B, but the difference was not statistically significant.


CONCLUSIONS
5-aminolaevulinic acid-induced FC during TUR reduces the recurrence rate in stage Ta/T1 bladder TCC. The most significant benefit is in patients with multiple and recurrent tumours.
Babjuk
Marko
M
Department of Urology, General Teaching Hospital, Charles University, Postgraduate Institute, Praha, Czech Republic. marko.babjuk@lf1.cuni.cz
Soukup
Viktor
V
Petrík
Radko
R
Jirsa
Milan
M
Dvorácek
Jan
J
D000368:Aged; D000622:Aminolevulinic Acid; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000601:surgery; D003558:Cystoscopy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D017319:Photosensitizing Agents; D011446:Prospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid