[Fluorescence diagnosis and photodynamic therapy in urology].
Urology is a preferential domain of endoscopy and as such an important research field for photodynamic procedures. An important milestone in the long-lasting and successful history of "photodynamics" in urology is the European approval of hexaminolevulinate (HAL, Hexvix) for fluorescence cystoscopy. All clinical studies carried out so far have demonstrated a significant increase in sensitivity of fluorescence versus standard cystoscopy for the detection of bladder cancer, especially concerning carcinoma in situ. The majority of the randomised, two-armed studies additionally show significantly reduced rates of residual tumour and recurrences. Tumor-selective fluorescence can also be observed in the kidney and prostate. Intraoperative fluorescence detection might thus simplify the achievement of high rates of R0 resections. Apart from the diagnostic potential of "photodynamics", also some possible therapeutic indications will be mentioned, including photodynamic therapy of bladder cancer and prostate cancer. Whereas initial clinical experience has been obtained for photodynamic therapy of bladder cancer, clinical studies for other indications are currently being designed. By providing an overview over methods and procedures as well as hitherto the available clinical results, we hope to provide reader with a basis for obtaining his/her own judgement.
Stepp
H
H
Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München. herbert.stepp@med.uni-muenchen.de
Waidelich
R
R
D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D003558:Cystoscopy / Q000379:methods*; D017484:Dermatitis, Phototoxic; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local; D010778:Photochemotherapy / Q000295:instrumentation; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D011471:Prostatic Neoplasms / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester