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Review
. 2020 Jun 8;10(6):383.
doi: 10.3390/diagnostics10060383.

Shedding Light on Bladder Cancer Diagnosis in Urine

Kit Man Chan  1 , Jonathan Gleadle  2   3 , Jordan Li  2   3 , Krasimir Vasilev  1   4 , Melanie MacGregor  1   4
Affiliations
Review

Shedding Light on Bladder Cancer Diagnosis in Urine

Kit Man Chan et al. Diagnostics (Basel). .

Abstract

Blue light cystoscopy (BLC) is the most recent clinical approach in the detection and diagnosis of bladder cancer, a common type of cancer with a high rate of recurrence. Representing a significant advance over previous approaches, this photodynamic diagnostic technique uses a photosensitiser prodrug as an adjunct to white light cystoscopy to enhance the in vivo detection of malignant tissues in the bladder based on their distinctive fluorescence. Whilst it does improve detection rates, BLC remains an invasive and costly procedure. Meanwhile, a variety of noninvasive urine detection methods and related microdevices have been developed, none of which have yet entered routine clinical use due to unsatisfactory sensitivity. Following a brief description of the current approaches and their limitations, we provide here a systematic review of a newer niche research aiming to develop a noninvasive adaptation of photodynamic diagnosis. The research to date surrounding the ex situ use of photosensitiser prodrugs for urinary diagnosis of bladder cancer is also discussed.

Keywords: 5-ALA; bladder cancer; noninvasive; photodynamic diagnosis; urinary biomarkers; urine.

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Conflict of interest statement

J.G., K.V. and M.M. are investors on patents seeking to capture cancer cells from urine.

Figures

Figure 1
Figure 1
Infographic illustrating the currently available (yellow boxes) and potential microdevices (colour bordered boxes) for urinary bladder cancer diagnosis, as described in Table 1 and Table 2 below.
Figure 2
Figure 2
The principle of photodynamic diagnosis (PDD) of 5-ALA mediated protoporphyrin IX (PpIX) in tumour cells (a); molecular structure of PpIX and fluorescence spectrum (b), following excitation with violet blue light at 405 nm, PpIX emits a red fluorescence of 635 nm.
Figure 3
Figure 3
White light (a) and blue light fluorescence (b) endoscopic image of a flat tumour in situ (Tis). 5-ALA solution was instilled intravesically before cystoscopy. This is revealed by reddish fluorescence when using fluorescence cystoscopy. Reproduced with permission of John Wiley and Sons on behalf of the British Journal of Urology (BJU) International [50].
Figure 4
Figure 4
St. John’s wort (a). Reproduced with permission of photographer [55]; molecular structure of hypericin and the fluorescence spectrum of hypericin (b).
Figure 5
Figure 5
Flow diagram of evidence acquisition.
See this image and copyright information in PMC

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