A new method for detecting bladder tumours will provide improvements for patients' treatment and a reduction in cancer recurrence rates. In a review article appearing online in Nature Clinical Practice Urology, J Alfred Witjes and Jude Douglass compare this method with traditional methods and suggest that it could also prove more cost-effective in the diagnosis and management of bladder cancer.
Bladder cancer detection is still not perfect - despite the introduction of urinary markers the recurrence of tumours remains high. It is thought that this is partly the result of tumour cells being left behind following surgery. Fluorescence cystoscopy offers better visualization of bladder tumours than the traditional method of white-light cystoscopy, facilitating a more complete removal of the tumours during surgery. Studies have also confirmed that more tumours are detected by this method leading to reduced recurrence rates.
The authors discuss two types of fluorescence cystoscopy in their comparison with traditional white-light cystoscopy: Hexaminolevulinate (HAL) and 5-aminolevulinic (ALA) fluorescence cystoscopy. They argue that HAL offers several advantages over ALA for cystoscopy in patients with suspected bladder tumours as it is easier to use and improves the visibility of tumours. They also point out that fluorescence cystoscopy is associated with a small increase in the number of false positives compared to the traditional white-light technique. Studies into methods of reducing the false positive rate with HAL are underway.
J Alfred Witjes (University Medical Centre, Nijmegen, Netherlands)
Free article available online.
(C) Nature Clinical Practice Urology press release.
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