Hexyl aminolevulinate fluorescence cystoscopy in bladder cancer

Abstract

Although bladder cancer occurs frequently, early diagnosis and complete removal of malignant lesions usually lead to good clinical outcomes. In the USA, white light cystoscopy (WLC) is commonly used for bladder cancer diagnosis and guidance of the surgical resection. However, with WLC malignant and precancerous lesions may be missed, resulting in a high rate of disease recurrence. Monitoring for and treating these recurrences carry high direct and indirect costs. Because hexyl aminolevulinate (HAL; 5-ALA-hexylester) fluorescence cystoscopy has greater sensitivity than WLC, especially for detecting early stage lesions, and its use provides more complete resection and lower disease recurrence, it has been recommended in European clinical guidelines. This article reports our own HAL experiences and first time recurrence data, describes how HAL was developed, provides key clinical trial results, and discusses how HAL, which has revolutionized fluorescence cystoscopy and bladder cancer care in Europe, may ultimately revolutionize bladder cancer care in the USA.

Keywords::

• 5-aminolevluinic acid
• 5-aminolevulinate acid
• bladder cancer
• diagnosis
• fluorescence cystoscopy
• hexyl aminolevulinate
• photodynamic diagnostic tool
• recurrence-free survival
• sensitivity
• specificity
• transurethral resection of bladder tumor
• treatment

Financial & competing interests disclosure

Karl Sievert and Stephan Kruck are consultants for GE Healthcare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.