Bladder Cancer presentations at AUA2025: Blue Light Cystoscopy improves risk stratification and informed decision making

Key Takeaways:

• Blue Light Cystoscopy detects malignant bladder cancer lesions missed by traditional methods.
• BLC leads to upstaging or upgrading of tumors in 9.3% of patients, affecting treatment plans.
• BLC aids in better risk stratification and predictive modeling for non-muscle invasive bladder cancer.

At the American Urological Association’s annual conference (AUA2025) in Las Vegas, Photocure ASA, known as “The Bladder Cancer Company,” presented four groundbreaking studies demonstrating the benefits of Blue Light Cystoscopy (BLC) in improving the management of bladder cancer.

Enhancing Detection with Blue Light Cystoscopy

One of the key studies, led by Dr. Alireza Ghoreifi of Duke University, analyzed data from 2,854 patients with non-muscle invasive bladder cancer (NMIBC) enrolled in Photocure’s U.S. Blue Light Cystoscopy with Cysview Registry. The findings revealed that 7% of patients had at least one malignant lesion detected exclusively by BLC while having a negative White Light Cystoscopy (WLC).

“These additional lesions included carcinoma in-situ (CIS) at 43%, high-grade Ta at 28%, and high-grade T1 at 11%,” the study reported. As a result, “the rate of upgrading or upstaging to a more advanced tumor using BLC was 9.3%.”

Impact on Patient Management

The implications of these findings are significant. Upgrading or upstaging tumors can directly influence patient management, including decisions regarding intravesical therapy, treatment duration, and the timing of radical cystectomy. The study suggests that BLC-enhanced detection could form the basis for further research into how this technology supports precision diagnostics and improves patient outcomes in NMIBC.

Predicting Recurrence and Progression

Another study presented by Dr. Boris Gershman from Harvard University’s Beth Israel Deaconess Medical Center focused on developing predictive models for recurrence and progression in patients undergoing BLC-aided transurethral resection of bladder tumor. The study included 1,109 patients with a median age of 71 years, of whom 18% were female.

During the follow-up period, there were 360 recurrence events and 79 progression events. The research identified factors associated with increased risks, such as a greater number of tumors (hazard ratio [HR] 1.09) and recurrent tumor status (HR 1.32) for recurrence. Higher tumor stages, specifically T1 (HR 3.88) and T1 with CIS (HR 3.69), along with lymphovascular invasion (HR 3.88), were linked to increased risks of progression.

Refining Risk Stratification

These models highlight the role of BLC in refining risk stratification for NMIBC patients. By identifying high-risk features more accurately, urologists can tailor treatment plans more effectively. For instance, patients with pure CIS (HR 0.69) and those receiving perioperative intravesical chemotherapy (HR 0.76) were associated with decreased risk of recurrence, guiding less aggressive treatment approaches.

Advancing Informed Decision-Making

The studies underscore the importance of BLC in enhancing diagnostic accuracy and supporting informed decision-making for both physicians and patients. By detecting additional malignant lesions and providing better risk assessment, BLC has the potential to improve clinical outcomes and shape future guidelines in bladder cancer management.