Patient Types

Use Blue Light Cystoscopy (BLC™) with Cysview in patients with non-muscle invasive bladder cancer. Use during the initial TURBT and in surveillance cystoscopies for intermediate and high-risk patients.

Consider for patients who:

  • Are getting their first TURBT because of suspicion of NMIBC based on a previous cystoscopy
  • Are undergoing repeat resection post initial TURBT
  • Are being checked to assess response to BCG therapy
  • Are undergoing surveillance
  • Are going to receive intravesical therapy when residual disease is suspected
  • Had a positive cytology and negative White Light Cystoscopy (WLC)

At Initial TURBT on Suspicion of NMIBC1-5

AUA/SUO Guideline: 

In a patient with NMIBC, a clinician should offer BLC with Cysview, if available, to increase
detection and decrease recurrence. (Moderate Recommendation; Evidence Strength: Grade B)2

From a prospective, comparative, within patient controlled, multicenter phase III study in the detection of Ta/T1 tumors in patients who had previously undergone a cystoscopy and had suspicion of or confirmed NMIBC:

Out of 286 patients with at least one Ta or T1 tumor, 16% were detected only with BLC with Cysview (p=0.001).3,4

2018 Consensus Panel of NMIBC experts:

Strong recommendation to use BLC with Cysview.5

Repeat TURBT1,5

2018 Consensus Panel of NMIBC experts:

Blue Light Cystoscopy with Cysview with either flexible or rigid scope is strongly recommended in intermediate and high-risk patients.5

Following Treatment with BCG1,5

The decision to use BLC with Cysview in this instance should be made on a patient-by-patient basis by taking into account the benefit from accurately diagnosing more clinically significant disease cases versus the risk of false positives. The incidence of false positives decreases as time from BCG therapy increases.1

2018 Consensus Panel of NMIBC experts:

This scenario is an important endpoint for flexible and rigid Blue Light Cystoscopy with Cysview in high-risk patients.5

In Surveillance1,3-6

From a prospective, comparative, open-label, within patient controlled, multicenter phase III study in the detection of bladder cancer during surveillance:

At surveillance, 21% of recurrent patients were only found with BLC with Cysview (p<0.0001).3,6

2018 Consensus Panel of NMIBC experts:5

For intermediate-risk patients

  • At 3-month surveillance with flexible scope
  • At HCP-determined frequency during surveillance for 2 years

For high-risk patients

  • At 3-month surveillance with flexible scope
  • At 6-month follow-up surveillance with flexible scope
  • At every other follow-up for 2 years

Prior to Intravesical Therapy When Residual Disease is Suspected5

2018 Consensus Panel of NMIBC experts:

A majority of the panel (13/17) thought that Blue Light Cystoscopy with Cysview would be of benefit before initiating intravesical therapy in patients at intermediate risk or high risk of recurrence, based on the patient’s not having undergone a previous TURBT using BLC with Cysview.5

In Patients with Positive Cytology and Negative White Light Cystoscopy1-2,5

AUA/SUO Guideline:

In patients with a positive cytology and negative WLC, a clinician should consider prostatic urethral biopsies and upper tract imaging, as well as enhance cystoscopic techniques (BLC, when available), ureteroscopy, or random biopsies. (Expert Opinion).2

2018 Consensus Panel of NMIBC experts:

Flexible Blue Light Cystoscopy with Cysview may be used in low, intermediate and high-risk patients. The panel agreed with the AUA/SUO NMIBC Guideline on the need for biopsy, but also considered that flexible BLC could be helpful in determining which operative procedure might be necessary.5

1 Daneshmand S, Schuckman AK, Bochner BH, et al. Hexaminolevulinate Blue-Llight Cystoscopy in Non-Muscle-Invasive Bladder Cancer: Review of the Clinical Evidence and Consensus Statement on Appropriate Uuse in the USA. Nat Rev Urol. 2014;11(10):589-596.

2  American Urological Association/Society of Urologic Oncology Non-Muscle Invasive Bladder Cancer Guideline 2016. https://www.auanet.org/guidelines/bladder-cancer-non-muscle-invasive-(2016)#x2572. Published 2016. Accessed January 17, 2019. 

Cysview [prescribing Information]. 2018:1-14.

4 Stenzl A, Burger M, Fradet Y, et al. Hexaminolevulinate Guided Fluorescence Cystoscopy Reduces Recurrence in Patients with Nonmuscle Invasive Bladder Cancer. J Urol. 2010;184(5):1907-1914. 

Lotan Y, Bivalacqua TJ, Downs T, et. al. Blue Light Flexible Cystoscopy with Hexaminolevulinate in Non-Muscle Invasive Bladder Cancer: Review of the Clinical Evidence and Consensus Statement on Optimal Use in the USA — Update 2018. Nat Rev Urol. 2019; pending. [Epub ahead of print]. 

6 Daneshmand S, Patel S, Lotan Y, et al. Efficacy and Safety of Blue Light Flexible Cystoscopy With Hexaminolevulinate (HAL) in the Surveillance of Bladder Cancer: A Phase III, Comparative, Multi-Center Study. J Urol. 2018;199(5):1158-1165.