Photodynamic therapy for bladder carcinoma: Today's medicine or tomorrow's horizon?

Transitional cell carcinoma (TCC) of the bladder has a 40-70% local recurrence rate when treated with transurethral resection (TURBT)(1) and carcinoma in situ (CIS) has a 54-83% recurrence rate within 4 years(2). Today, the main therapy is intravesical chemotherapy, of which Bacillus Calmette-Guerin (BCG) is the most effective. However, because chemotherapy is only modestly beneficial(3) and most bladder carcinomas will not respond to second course of BCG(4), an additional treatment modality is being researched. Photodynamic therapy (PDT) combines a photosensitizing dye with laser therapy to destroy cancer cells. Pathologic cells take up the photo sensitizing agent and upon activation by visible light (400 - 760 nm) the cancerous cells are destroyed. PDT can be used for focal or diffuse disease. It also can be used to treat recurrent and refractory superficial TCC, in addition to being used as a prophylactic measure. We review the literature (mostly retrospective or nonrandomized studies) that supports the use of PDT for TCC of the bladder. While PDT seems to be a very promising treatment modality, BGC intravesical treatment remains the standard of care for TCC. However if additional randomized trials confirm current data, PDT may soon be a recommendable option.