What is it about?

For some people, early (non-muscle invasive) bladder cancer comes back after it is first treated. Initial treatment for early bladder cancer involves surgery to remove the cancer (transurethral resection of a bladder tumour, TURBT). This surgery is done using a telescope put into the bladder through the urethra (cystoscopy). Surgery is normally done using a white light to allow the surgeon to see the cancer and remove it. However, there is an option to use blue light during surgery instead (photodynamic 'blue light' cystoscopy). A urethral catheter is placed into the bladder and a fluorescent tumour marker (Hexvix) is applied to the inside of the bladder, one hour prior to the cystoscopy. Bladder tumours then appear bright red when illuminated under blue light, allowing the surgeon to see more of the cancer and to remove it more effectively. It is not known if this blue light approach is better than standard white light surgery, and this is the focus of the PHOTO study.

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Why is it important?

Follow up of non-muscle invasive bladder cancer (NMIBC) patients is difficult. Cystoscopic follow up can be required up to 4 times/year and makes bladder cancer have one of the highest lifetime treatment costs per patient, associated with considerable burden for those affected. Although, BCG (Bacillus Calmette-Guerin) and mitomycin washes into the bladder help, active research into reducing recurrence through better removal of the cancer (resection) in the first instance, such as photodynamic guided resection (The PHOTO trial), is essential. The purpose of PHOTO is to find out whether using blue light during surgery means that the cancer is less likely to come back within 3 years after treatment.


Although photodynamic 'blue light' cystoscopy is recommended for the detection of carcinoma in situ (CIS) by the 2006 European Association of Urology (EAU) guidelines, the technique has not yet been introduced into routine urology. Use of conventional white-light cystoscopy and voided/bladder-wash cytology remains the standard of care for initial assessment and follow-up of bladder cancer. The outcomes from the PHOTO trial will determine whether photodynamic surgery guided by a fluorescent tumour marker is better than conventional white light surgery and whether use is worthwhile for the NHS.

emma clark
Newcastle University

Read the Original

This page is a summary of: Photodynamic versus white light-guided treatment of non-muscle invasive bladder cancer: a study protocol for a randomised trial of clinical and cost-effectiveness, BMJ Open, September 2019, BMJ, DOI: 10.1136/bmjopen-2018-022268.
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