title: Transurethral resection of non-muscle-invasive bladder transitional cell cancers with or without 5-aminolevulinic Acid under visible and fluorescent light: results of a prospective, randomised, multicentre study.
abstract: BACKGROUND
  Fluorescent light (FL)-guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has been reported to detect more tumours compared with standard white-light (WL) cystoscopy. Most reports are from single centres with relatively few patients.
  
  
  OBJECTIVE
  To evaluate whether 5-ALA-induced FL and WL cystoscopy at transurethral resection (TUR) is superior compared with standard procedures under WL only with respect to tumour recurrence and progression in patients with non-muscle-invasive bladder cancer.
  
  
  METHODS
  This randomised, multicentre, observer- and pathologist-blinded, prospective phase 3 clinical trial enrolled 300 patients, and of those patients, 153 were randomised to FL cystoscopy and 147 were randomised to standard WL cystoscopy.
  
  
  METHODS
  All patients were first inspected under WL and all lesions were recorded. Patients randomised to FL underwent a second inspection. TUR was carried out in both groups.
  
  
  METHODS
  Control cystoscopy under WL was performed in all patients every 3 mo during the first year after randomisation and biannually thereafter.
  
  
  CONCLUSIONS
  At the first TUR, the mean number of resection specimens per patient was 2.5 (FL: 2.5; WL: 2.4; p=0.37) and the resulting mean number of resected tumours was 1.7 with FL and 1.8 with WL (p=0.85). More patients were diagnosed with carcinoma in situ (CIS) in the WL group (13%) than in the FL group (4.2%). Within-patient comparison of FL patients only showed that FL detected more lesions than WL. Tumour lesions solely detected by FL cystoscopy that would not otherwise be detected by WL cystoscopy included 52% dysplasia, 33% CIS, 18% papillary neoplasms, 13% pT1, and 7% pTa. Outcome at 12 mo did not show any difference between groups with regard to recurrence-free and progression-free survival rates.
  
  
  CONCLUSIONS
  In this prospective, randomised, multi-institutional study, we found no clinical advantage of FL cystoscopy compared with WL cystoscopy and TUR.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Department of Urology, Stockholm, Sweden. Martin.Schumacher@ki.se
authors.forename: Martin C
authors.initials: MC
authors.lastname: Schumacher
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidsson
authors.forename: Bengt
authors.initials: B
authors.lastname: Friedrich
authors.forename: Jörgen
authors.initials: J
authors.lastname: Pedersen
authors.forename: N Peter
authors.initials: NP
authors.lastname: Wiklund
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D003558:Cystoscopy; D004311:Double-Blind Method; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
chemical_list: D000622:Aminolevulinic Acid