Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrencerate in superficial bladder cancer

Purpose: Several investigators have demonstrated an approximately 20% highe r tumor detection rate by Ei-aminolevulinic acid (ALA) fluorescence endosco py compared to standard white light cystoscopy, and suggested a reduction i n tumor recurrences when fluorescence endoscopy was performed as standard p rocedure during transurethral resection. We test this hypothesis. Materials and Methods: In a prospective randomized multicenter study 102 pa tients underwent transurethral resection of bladder tumor(s) either with wh ite light or ALA fluorescence assisted endoscopy. A second look transurethr al resection with ALA fluorescence endoscopy was performed 6 weeks after th e initial operation. Results: At second look transurethral resection tumor was detected in 20 of 51 patients (39%) in the white light group and in 8 of 51 (16%) in the ALA fluorescence endoscopy group. This difference was statistically significan t (p = 0.005). Conclusions: ALA fluorescence endoscopy is an innocuous and inexpensive dia gnostic procedure that significantly improves bladder tumor detection rates compared to standard white light endoscopy. In our controlled study ALA fl uorescence endoscopy reduced the residual tumor detection rate at second lo ok transurethral resection by 59%.