5‐aminolaevulinic acid‐induced fluorescence cystoscopy during transurethral resection reduces the risk of recurrence in stage Ta/T1 bladder cancer

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>To assess the influence of 5‐aminolaevulinic acid‐induced fluorescence cystoscopy (FC) during transurethral resection (TUR) on the recurrence rate and the length of tumour‐free interval in stage Ta/T1 transitional cell carcinoma (TCC) of the urinary bladder.</jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS</jats:title><jats:p>In all, 122 patients with primary or recurrent stage Ta/T1 bladder TCC treated with TUR were enrolled in a prospective randomized study. In group A the TUR was performed with standard white‐light endoscopy, and in group B with FC. The patients were followed using standard cystoscopy and urinary cytology. The recurrence‐free interval was evaluated in whole groups, for single and multiple, and for primary and recurrent tumours separately.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>At the time of the first cystoscopy (10–15 weeks after TUR) tumour recurrence was detected in 23 of 62 patients (37%) in group A, but only in five of 60 patients (8%) in group B. The recurrence‐free survival rates in group A were 39% and 28% after 12 and 24 months, compared to 66% and 40% respectively in group B (<jats:italic>P</jats:italic> = 0.008, log‐rank test). In separate analyses, the recurrence‐free survival rates were significantly higher using FC in multiple (<jats:italic>P</jats:italic> = 0.001) and in recurrent (<jats:italic>P</jats:italic> = 0.02) tumours. In solitary and primary tumours the median time to recurrence was also longer in group B, but the difference was not statistically significant.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p>5‐aminolaevulinic acid‐induced FC during TUR reduces the recurrence rate in stage Ta/T1 bladder TCC. The most significant benefit is in patients with multiple and recurrent tumours.</jats:p></jats:sec>