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The role of hexaminolevulinate fluorescence cystoscopy in bladder cancer

Abstract

Non-muscle-invasive bladder cancer is labor intensive and costly to manage. Owing to long-term survival rates and life-long monitoring and treatment, it is the most expensive cancer to manage in per-patient terms. Significant costs are attributable to the treatment of recurrences and complications. Fluorescence-guided cystoscopy, using 5-aminolevulinic acid (ALA) or its hexyl ester, hexaminolevulinate 5-ALA (Hexvix® [HAL], Photocure, Oslo, Norway), improves the detection of bladder tumors, particularly carcinoma in situ, compared with standard white-light cystoscopy. The quality of transurethral resection of the bladder tumor is also improved. It has been shown that improved tumor detection leads to better patient management and, in the case of ALA, reduced long-term recurrence rates and costs. Long-term studies in this area with HAL are ongoing. The technique is well tolerated and is a useful adjunct to white-light cystoscopy.

Key Points

  • Fluorescence cystoscopy with 5-aminolevulinate (ALA) and its derivatives improves the imaging of lesions in the bladder

  • Fluorescence cystoscopy is particularly useful at improving the detection of flat lesions, such as CIS

  • Improved detection rates with fluorescence cystoscopy lead to better management of patients with non-muscle-invasive bladder cancer

  • The use of ALA fluorescence cystoscopy to diagnose and treat patients with bladder cancer leads to a reduction in recurrence rates

  • Fluorescence cystoscopy is cost-effective in the diagnosis and treatment of bladder cancer

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Correspondence to J Alfred Witjes.

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Competing interests

JA Witjes has acted as an investigator on a study supported by and has received a lecture honorarium from Photocure (Oslo, Norway). He has also acted as an advisor for and received a lecture honorarium from GE Medical.

J Douglass is a consultant for Photocure (Oslo, Norway), which has involved writing up a clinical trial.

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Witjes, J., Douglass, J. The role of hexaminolevulinate fluorescence cystoscopy in bladder cancer. Nat Rev Urol 4, 542–549 (2007). https://doi.org/10.1038/ncpuro0917

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  • DOI: https://doi.org/10.1038/ncpuro0917

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