New Therapeutic Horizons of Bladder Cancer
Written by:The professor. Tommaso Brancato, an Urology expert in Rome , talks about the latest novelties in bladder cancer therapy, a disease affecting nearly 3 million people
Bladder cancer is the second most common cancer of the urinary tract. It is estimated that around 2.7 million people in the world have had a bladder cancer and that of these they die about 145,000 each year.
How do you recognize a bladder cancer?
The definitive diagnosis, the stage of the disease and consequently the subsequent therapeutic and prognostic route of bladder cancer are determined by the endoscopic bladder resection (TUR Bladder). It provides information on the degree and stage of the disease. Fundamental during TURB is that the resection is deep enough to exclude a muscle layer invasion by the neoplasia. However, cystoscopy has proved to be insufficient, especially in the case of flat lesions, such as areas of dysplasia or in situ carcinoma (CIS).
Bladder tumor: the new therapeutic horizons
The high risk of tumor progression is approximately 45-50% and to avoid a second endoscopic bladder resection it is necessary to minimize the risk of incomplete removal of the tumor (variable risk between 30% and 40%) or not recognize flat lesions (risk of 53%). Therefore, research has sought to develop new methods such as Narrow Band Imaging (NBI) and Fluorescence Cystoscopy (PDD).
Fluorescence cystoscopy for bladder cancer
Fluorescence Cystoscopy (PDD) has been developed to improve the diagnosis and prognosis of bladder cancer. Instillation within the bladder of photoactive substances (5-aminolevulinic acid) one hour before endoscopic resection makes the fluorescence characteristic and color fuchsia tumor tissue when lit with blue light (400 nm).
What are the results of fluorescence cystoscopy for bladder cancer?
Recent randomized, prospective studies have followed more than 1,000 patients and the findings indicate an increase in free-period illness with a decrease in the rate of recurrence between 2.4 and 4.9% for fluorescence cystoscopy (PDD) versus 13.3 / 16.2 % of white light. This decrease corresponds to a statistically significant duration of free-period illness (up to 16.4 months). Moreover, studies show increased tumor sensitivity (up to 95.8%), which is specific for low-grade pTa (95.3 vs 87.1%) tumors and, of course, for the most serious and aggressive carcinoma in situ (95.2% vs 71.4 %).
Fluorescence Cystoscopy: Advantages and Advances for Bladder Cancer
In a paper published in April 2013 on the Canadian Journal of Urology, it is highlighted that the introduction of 5-aminolevulinic acid in cystoscopic diagnosis has led to a reduction of approximately $ 5000.00 per patient during a follow- up lasted 4.5 years. The methodology has recently been included with therapy standards in many European countries and in the guidelines of the European Urology Association.
The professor. Tommaso Brancato has over 600 experienced endoscopic fluorescence resuscitation patients from 2011 to date with brilliant results in terms of reduced recurrence and prolonged free period of illness, as well as a reduction in the number of total cystectomies performed by a better resection of primitive neoplasia.
Editor: Marta Buonomano