BRAVO Study: Blue Light Cystoscopy Reduces Recurrence in Patients With NMIBC

The BRAVO study, led by Ali Nasrallah, MD, and Sanjay Das, MD, has provided new insight into the efficacy of blue light cystoscopy (BLC) over white light cystoscopy (WLC) on the oncologic outcomes of patients with non–muscle invasive bladder cancer (NMIBC).

Although the current standard of care for diagnosing bladder cancer is WLC, previous research has shown that BLC can provide improved detection rates, mainly for high-risk disease and invasive tumors, and is recommended for use in patients with known or suspected NMIBC.

Patients were identified from the Veterans Affairs Healthcare System. A total of 626 patients diagnosed with NMIBC between 1997 and 2021 were included in the study. The primary objective was to determine recurrence and progression-free survival through multivariable Cox proportional hazards regression models.

A total of 313 patients underwent BLC, and 313 patients underwent WLC. Of 626 patients, 381 (61%) had high-risk disease, and 159 (25%) experienced bladder cancer recurrence. The median follow-up was 3.7 years, and at 3 years, recurrence risk was significantly reduced in patients who underwent BLC compared with those who underwent WLC (hazard ratio [HR], 0.62; 95% CI, 0.45-0.86; P<0.01).

Progression risk was also reduced at 3 years but was not statistically significant (HR, 0.71; 95% CI, 0.37-1.38; P=0.32). Patients who underwent BLC were significantly more likely to receive intravesical bacillus Calmette-Guérin (61% vs 43%; P<0 .01) or intravesical chemotherapy (48% vs 27%; P<0.01) compared with those who underwent WLC.

BLC was linked to a reduced risk of recurrence in patients with NMIBC, as well as increased use of intravesical therapies, shedding light on the benefits of BLC.