Photodynamic Diagnosis Mediated by 5-Aminolevulinic Acid for Urinary Bladder Cancer
5-Aminolevulinic acid (ALA) is an endogenous natural amino acid, and has recently been attracting attention as a new-generation photosensitive substance for photodynamic diagnosis (PDD). In the urology field, ALA-mediated PDD (ALA-PDD) has already been approved for the intraoperative diagnosis of non-muscle invasive bladder cancer (NMIBC) as a novel fluorescence-guided navigation technology approved in Europe and United States, whereas in Japan, ALA is waiting for approval as a photosensitizer for bladder cancer. Moreover, ALA-PDD is also clinically applied for the diagnosis of upper urinary tract cancer, prostate cancer, and renal cancer. This chapter outlines ALA-PDD for urinary bladder cancer.
Keywords5-Aminolevulinic acid (ALA) Photodynamic diagnosis (PDD) Protoporphyrin IX (PpIX) Fluorescence cystoscopy Non-muscle invasive bladder cancer (NMIBC) Transurethral resection of bladder tumor (TURBT)
There were multiple papillary tumors. ALA-PDD could show red fluorescence of these tumors themselves and also the outskirts of these tumors. In particular, a tiny and flat lesion could be detected only by ALA-PDD in the right posterior wall of urinary bladder. Moreover, the floating of a lot of bladder cancer cells with PDD-fluorescence (MP4 87,401 kb) could be detected.
In TURB, bladder tumor is scraped with the looped type of electrical scalpel under the cystoscopic observation. TURB under ALA-PDD enable to confirm the correct surgical margin by navigation of red fluorescence. The residual lesions with red fluorescence at the resected margin could be resected additionally and exactly (MP4 201,878 kb)
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