What are the EAU recommendations for surgical treatment of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The EAU guidelines recommend fluorescence-guided resection, as it is more sensitive than white-light cystoscopy alone for detection of tumors, particularly CIS. [105, 106, 107] The FDA has approved blue-light cystoscopy with hexaminolevulinate (Cysview) as an adjunct to white-light cystoscopy in patients suspected or known to have non–muscle-invasive papillary cancer of the bladder on the basis of a prior cystoscopy. This technique is not a replacement for random bladder biopsies or other procedures used in the detection of bladder cancer and is not for repetitive use.

Blue-light cystoscopy with hexaminolevulinate detects more Ta/T1 bladder cancer lesions than does white-light cystoscopy alone. [105, 106, 107, 108, 109] (See the image below.) Stenzl et al reported that in patients with Ta or T1 tumors, at least one of the tumors was seen only with fluorescent cystoscopy in 16% of patients. [110] Improved detection leads to improved tumor resection, as every tumor detected is resected in the same TURBT. [111]

Bladder cancer. (A) When infused into the bladder, Bladder cancer. (A) When infused into the bladder, the optical imaging agent hexaminolevulinate (Cysview) accumulates preferentially in malignant cells. (B) On blue-light cystoscopy, the collection of hexaminolevulinate within tumors is visible as bright red spots. Courtesy of Gary David Steinberg, MD, FACS.

No further metastatic workup is needed for obviously superficial tumors. Because bladder cancer is a polyclonal field change defect, continued surveillance is mandatory.

See Transurethral Resection of Bladder Tumors for more information on this topic.


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