Photodynamic therapy of bladder carcinoma.

Photodynamic therapy for bladder cancer is an intriguing modality with theoretical potential for successful treatment of visible tumor and areas of carcinoma in situ and dysplasia throughout the bladder mucosa. There remain many unanswered determinations about photodynamic therapy, including the most effective photosensitizer, the dose of laser that should be used, and the optimum timing for laser therapy following the injection of photosensitizer. Nonetheless, clinical studies thus far have shown photodynamic therapy to have efficacy in eradicating superficial noninvasive tumors. Treatment of diffuse carcinoma in situ at present appears the most impressive. Prospective studies designed to examine photodynamic therapy in a standardized protocol in comparison with other conventional methods for treatment and prophylaxis of noninvasive bladder cancer are most needed and are currently in progress. In the future, development of alternate photosensitizers or methods of direct intravesical uptake of DHE, perhaps limiting cutaneous phototoxicity, are expected.