title: Should fluorescence cystoscopy be used for transurethral resection in patients with high-grade T1 bladder cancer?
abstract: This Practice Point commentary discusses the study by Denzinger et al. in which patients with high-grade T1 (HGT1) bladder cancer were treated by transurethral resection with either white-light cystoscopy or fluorescence cystoscopy. Over a median follow-up duration >7 years, the recurrence-free survival was significantly improved in the fluorescence cystoscopy group. No difference was observed between the two groups, however, in the rate of progression to muscle-invasive disease, although the low number of progression events limited the power of this comparison. As such, a low threshold for radical cystectomy should be maintained in transurethrally resected HGT1 disease, regardless of the visualization technique used. Importantly, fluorescence cystoscopy represents a more costly and time-consuming procedure than does white-light cystoscopy. Larger clinical trials, as well as research at the molecular level, are needed to define the potential role of fluorescence cystoscopy in the treatment of HGT1 disease.
authors.affiliation: Urologic Oncology and Minimally Invasive Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA. mkatz2@surgery.bsd.uchicago.edu
authors.forename: Mark H
authors.initials: MH
authors.lastname: Katz
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg