Editorial Commentary on Gregers et al.

To the Editor,

What’s the matter with non-invasive low-grade bladder cancer? Well, to be honest, it is a nuisance. A bother. The real matter is not the cancer, which it is by definition and nomenclature. The real matter is the treatment related efforts. The eternal cycle of cystoscopy-TURBT-instillation-cystocopy, and so on. So here come Hermann Gregers and his coworkers [1]. And they simply destruct bladder tumors with a laser. No anesthesia to speak of, no hospitalization, not even a day missed at work. They tackle cases with obvious low-grade cancers, since all patients had seeming recurrences of previous low-grade bladder cancer. They survey them well even taking a biopsy, again on an outpatient base. They use PDD whenever scoping and a novel imaging tool, Image 1 S. And what’s their message?

You can do it. That simple. The laser destruction is no greater bother. It is safe. The biopsies performed at month one revealed but two low-grade dysplasias, which have no real significance, to be honest. So that’s 100% success. And recurrence rates later on were outright good given the mild treatment.

Any message on PDD and Image 1 S? No. These are both nice-to-haves. But certainly no necessities in this setting. Hermann Gregers provides no data suggesting any such needs. He just uses PDD to be on the safe side, while PDD is most valuable in detecting CIS. And Image 1 S detected no lesion of relevance.

Any message on economics? None I would believe to be universally valid. Danes and Germans have much in common. Much more than some Danes may like to admit, I must say. But despite all the geographical and cultural and sometimes maybe even emotional closeness- our health care systems vary dramatically. Hermann Gregers’ approach could not be practiced in Germany. Still I would believe his approach to be economically feasible.

And thus hope for his approach to be reevaluated on a larger scale, possibly without PDD and Image 1 S, which would further increase economically feasibility.