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2024 Amendment of AUA guideline for NMIBC includes the result of the PHOTO trial in UK, which did not find a difference in recurrence or progression rates over 44 months in intermediate- and high-risk NMIBC patients undergoing initial TURBT with BLC versus white light cystoscopy (WLC). According to the chief investigator Dr. Rakesh Heer – chair of urology at Imperial College of London, in the long term, field change (field cancerization) becomes a major factor for recurrence. Field change is a biological change which can happen to the lining of bladder likely due to ageing and long term exposure to toxicity which is excreted from kidneys. Field change makes the lining of bladder easier to change to malignancy. The result of the PHOTO trial in UK should reduce anxiety for some patients who are aware of BLC but do not have easy access to it. I have been following this subject about 5 years since BLC first became available for limited number of hospitals. I will post additional information.
The following is the amended section in American Urological Association (AUA) guidelines for NMIBC.
In a patient with NMIBC, a clinician should offer blue light cystoscopy (BLC) at the time of TURBT, if available, to increase detection and decrease recurrence. (Moderate Recommendation; Evidence Strength: Grade B)
The PHOTO trial, a randomized prospective trial, did not find a difference in recurrence or progression rates over 44 months in intermediate- and high-risk NMIBC patients undergoing initial TURBT with BLC versus white light cystoscopy (WLC). A group of 538 patients with initial clinical diagnosis of intermediate-/high-risk NMIBC were randomized to undergo either white light or blue light resection at several UK centers. At 44 months, the HR for recurrence was 0.94 (95% confidence interval [95% CI]: 0.69 to 1.28; P = .70). There was no difference in progression detected between groups (HR: 1.41; 95% CI: 0.67 to 2.96). CIS was present in only 13% of the resection specimens of patients enrolled in the trial; thus, a key group in which blue light detects the most “missed” tumors was under-represented in the study. Additionally, the trial was published prior to enrolling the full number of patients for adequate power to detect a difference between groups. Five other systematic reviews have shown decreased recurrence rates with the use of BLC compared to WLC.Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline: 2024 Amendment
“www.auajournals.org/doi/full/10.1097/JU.0000000000003846”
A Randomized Trial of PHOTOdynamic Surgery in Non–Muscle-Invasive Bladder Cancer
“evidence.nejm.org/doi/full/10.1056/EVIDoa2200092”
Effectiveness of photodynamic assessments in non-muscle invasive bladder cancer: real-life study by Dr. Herr
“www.youtube.com/watch?v=JKnCf8IVfls”
Photodynamic diagnosis in NMIBC: insights and impact of blue light surgery on recurrence rates
“www.youtube.com/watch?v=lAjtQXBvoAM”
Hi Joe:
These are unusual findings. I have always been under the impression that the blue light was a big help with detecting tumours. Several women in the Women’s Only support group have expressed interest in trying to have a blue light cysto but as we know only a few hospitals in Canada use it. Thanks for this data.
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