Carcinoma in situ (CIS) of the urinary bladder is hard to diagnose. The symptoms are highly unspecific and the small, flat CIS lesions can easily be missed, thus remaining unseen in standard white light cystoscopy. Photodynamic diagnosis (PDD) is recommended by the European Association of Urology (EAU) as a diagnostic procedure in cases of suspected CIS .
In a recent study published in the International Journal of Urology,.Photodynamic diagnosis of non–muscle-invasive bladder cancer (NMIBC) was shown to be feasible using oral 5-aminolevulinic acid (5-ALA), and transurethral resection of bladder tumors (TURBT) using a fluorescent light source with 5-ALA rather than white light. This test appears to have been well tolerated by patients.
While in Holistic Oncology, we are not obsessed with diagnosis (See File on Holistic Solutions), in Conventional Oncology, the more complexities, the more money and often the more complications. Hence, Conventional Treatment of bladder cancer is determined by many of diagnostic factors, factors that determine specific treatment plans, some of which may lead to a few “extra months” of Life for advanced cancers and others of which may give the advanced bladder cancer patient a few extra weeks.
Conventional Oncology is obsessed with an “accurate diagnosis” in order to target specific pathways that are eventually capable of reducing recurrence and progression risk. But is this serious when we know that cancer cells morph, mutate according to a continuous interplay of signaling networks.
While it’s true that conventional TURBT under a white light source can fail to detect 4% to 41% of small papillary tumors, carcinoma in situ, multifocal growth, and microscopic lesions (Ibid), while is equally true that guiding TURBT by photodynamic diagnosis with 5-ALA, (which induces fluorescence in tumor cells more than in healthy cells), was effective in a nonrandomized phase III study, (1), for Holistic Oncology, we immediately focus on the cancer control and reversal HIP protocol so that the major cancer cell growth pathways will be better controled, hindered and eventually, for many cases, reversed, whatever the complexities of the diagnosis.
Be that as it may, for those who are into tests, the photodynamic diagnosis results appear to be better as a conventional testing standard. The sensitivity of the fluorescent light source was 79.6% (144 of 181 tumor-positive specimens), which was significantly better than that of the white-light source, at 54.1% (98 of 181 specimens; P < .001). Forty-six of 181 of the tumor-positive samples (25.4%) were correctly diagnosed using only the fluorescent light source. (Ibid.)
There was some variation with regard to specific tumor types. The sensitivity of the fluorescent light source was 61.3% for flat urothelial tumors, compared with only 20.4% with white light (P < .01). For papillary urothelial tumors, the difference was smaller, at 100% with fluorescent light and 94.6% with white light (P = .046).
Most of the patients in the trial however (95.1%) experienced adverse events, but none died or stopped the study due to adverse events, and no grade 4 or higher events were seen. Six patients (eight cases) had grade 3 adverse events, including alanine transaminase elevation (4 cases), diabetes, bladder perforation, hypertension, and urticaria (1 case each).
The authors noted that the study was limited by its short observation time. “Although this trial found that ALA-photodynamic diagnosis enabled a more concise diagnosis of NMIBC with acceptable adverse event rates, this trial did not show whether a more concise diagnosis leads to improved recurrence-free or progression-free survival,” they wrote.
Still, they concluded that “TURBT with the fluorescent light source using oral 5-ALA can be the next standard treatment.” (Source) International Journal of Urology.
Discussion & Tentative Conclusion
A disadvantage of PDD is its rather low specificity, ranging from 35% to 66%, which is often due to a lack of experience on the part of the operator or the presence of scars after previous TURBT or intravesical instillation (2).
Nevertheless, for conventional and integrative oncology, PDD is recommended as a diagnostic tool in follow-up examinations of patients with CIS after BCG immunotherapy. (3)
Supporting this recommendation, in a study of 49 patients with CIS examined after BCG therapy, 18 cases of recurrence were noted. Of these 18 cases, white light cystoscopy revealed no CIS lesions, while PDD diagnosed 14. Overall, while nine of the PDD results were found to be false positives (33.3%), only one positively identified by white light cystoscopy was false (7.1%) (3).
For Conventional Oncology, PDD represents a great enhancement of the urological diagnosis of CIS of the urinary bladder and is a superior method to standard white light cystoscopy in cases where CIS is suspected. This efficiency is even more important when considering that a diagnosis of CIS demands the quick implementation of chemo-therapy.
From the viewpoint of ACRI’s version of Holistic Oncology however, all of this reasoning is absurd. First off, chemo and radiation make cancer stem cells stronger, they only kill fast growing tumor cells that dont metastasize. (Source) Hence, the chemo resistance and recurrence, which is an excellent “complication” for additional cash flow, but not so good for the patient. (Source) Secondly, chemo and radiation spur the growth of new cancer cells. (Source) And third, conventional oncology experts still dont take into consideration the circulatory tumor cells, let alone the circulatory cancer stem cells. It is these cells that determine recurrence and metastasis. (Source) Hence, the absurdity with the conventional obesession on testing and symptom destruction.
As noted, tumor symptomatology does not constitute the causation. Tumors are the results of blood, immune, microbiota, toxemia and metabolic disorders conventional oncology experts do not address.
Identifying tumors and then trying to kill them without addressing what causes most cancers, including removing the entire bladder and other organs before trying holistic oncology is or should be for the ACR Institute medical malpractice.
1. Babjuk M, Böhle A, Burger M, et al. Guidelines on Non-muscle invasive bladder cancer (Tar, T1 and Cis) European Association of Urology Guidelines. 2015;13:913. Available at: http://www.abnoba.de/fileadmin/Upload/Germany/DocCheck/Guideline_Non-muscle-Invasive-BC_TaT1_LR1.pdf.
2. Jocham D, Stepp H, Waidelich R. Photodynamic diagnosis in urology: state-of-the-art. Eur Urol. 2008;53:1138–48. [PubMed]
3. Colombo R, Naspro R, Bellinzoni P, Fabbri F, Guazzoni G, Scattoni V, Losa A, Rigatti P. Photodynamic diagnosis for follow-up of carcinoma in situ of the bladder. Ther Clin Risk Manag. 2007;3:1003–7. [PMC free article] [PubMed]