Because of the frequency of occurrence and the long protracted course, bladder
carcinoma is the most expensive solid
tumor in terms of costs, from diagnosis to death of the patient. The most important cost factor within the total cost is the treatment of recurrent, non-muscle invasive bladder
carcinoma. Photodynamic diagnosis (PDD) improves the early detection rate of
non-muscle invasive bladder cancer, especially the detection of
carcinoma in situ and severe dysplasia. PDD also reduces the number of
residual tumors after TUR-B compared to white-light guided TUR-B and also the early recurrence rate although long-term outcome with hexylaminolaevulinic
acid with regards to the general course of
bladder cancer is still lacking. PDD has been used mainly for detection of
bladder cancer and specifically
carcinoma in situ in conjunction with diagnostic and therapeutic transurethral resection of the bladder. In 2006 hexylaminolaevulinic
acid (HAL) was approved in the EU (EMEA) as a
photosensitizer for the use in photodynamic diagnosis of the bladder. Several guidelines have incorporated PDD as optional form of diagnosis during endoscopy in proven or suspected
bladder cancer, but no specific recommendations regarding indication and application of PDD exist. The German group of urologic oncology (AKO) invited urologists and biologists involved in the development of hexylaminolaevulinic
acid as well its clinical use to participate in evaluating the data for HAL and its predecessor delta-aminolaevulinic
acid (5-ALA). A consensus with regards to the indications,
contraindications, technique, pre-clinical data, comparison of HAL and 5-ALA, current results, costs and follow-up was reached and are presented in this paper.