2008 Volume 29 Issue 2 Pages 147-152
Photodynamic diagnosis (PDD) is clinically-recognized as an effective procedure of detection for various cancers. In the urological field the fluorescence in bladder tumors was first studied under ultraviolet light following the oral administration of tetracycline in the early 1960s. Present system of PDD with intravesical instillations of 5-aminolevulinic acid (ALA) as a photosensitizer for superficial bladder cancer was clinically reported in the early 1990s, and then drew keen attention.
Recently, it has proved PDD using ALA to be a procedure with an outstanding sensitivity for detection of superficial bladder cancer, in particular in the detection of flat lesions such as dysplasia and carcinoma in situ without additional complication. Furthermore, it was suggested that transurethral resection of bladder tumor (TURBT) guided PDD as an application of PDD reduced the risk of residual tumor and subsequent intravesical recurrence compared to conventional TUR-Bt in the patients with superficial bladder cancer. However, there are many problems concerning accuracy of diagnosis that remains to be solved such as false-positive findings and photobleaching phenomenon.
PDD using ALA is officially approved diagnostic procedure for superficial bladder cancer in Europe, and is also recommended by the degree of Grade B in the guideline of European Association of Urology (EAU), whereas in Japan, PDD was administered on a clinical trial basis under doctor's initiative. In this article, we review the present state of PDD using ALA for superficial bladder cancer.
