[Photodynamic diagnosis (PDD) in non-muscle invasive bladder cancer. Literature review]

Abstract

Non-muscle invasive bladder cancer is one of the most prevalent and incident neoplastic conditions in the Western world. Its clinical management involves significant costs for health systems. Diagnosis and treatment are based on direct visualization of the disease and on detection of flat forms having no specific morphology and which are sometimes overlooked. Prognosis of NMIBC often depends on quality of transurethral resection and on early detection of undifferentiated flat forms. Cystoscopy using photosensitive substances such as 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinic acid (HAL) achieves overdetection rates of 29 % for bladder neogrowths and 59% for carcinoma in situ. This overdetection ability results in an increased disease-free survival and a longer time to the first relapse. Increased costs resulting from use of these resources are compensated by a lower number of or delayed performance of cystectomies, resections, and instrumentations. It is concluded that PDD should be universally used, rather than in high risk patients only.that has been shown in both animal studies and human tumors.