Photodynamic diagnosis (PDD) for Bladder Cancer

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 [1].

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