Oncologic Outcomes of Blue Light Cystoscopy in an Equal Access Setting: Results of the BRAVO Study

Purpose: The purpose of this study was to compare the impact of blue light cystoscopy (BLC) vs white light cystoscopy (WLC) on the oncologic outcomes of nonmuscle invasive bladder cancer (NMIBC). Materials and Methods: We identified patients diagnosed with NMIBC between 1997 and 2021 in the Veterans Affairs Healthcare System. A 1:1 propensity score matching algorithm was used, accounting for baseline demographic and clinical variables. The primary objective was to determine recurrence and progression-free survival, using multivariable Cox proportional hazards regression models. Results: Among 626 matched patients (313 BLC and 313 WLC), median age at diagnosis was 71 years, 616 (98%) were male, 381 (61%) were high-risk NMIBC, and 159 (25%) had bladder cancer recurrence. Median follow-up was 3.7 years. Recurrence risk at 3 years was significantly reduced after BLC vs WLC (hazard ratio = 0.62; 95% confidence interval, 0.45-0.86; P < .01). Progression risk at 3 years was reduced; however, this was not statistically significant (hazard ratio = 0.71; 95% confidence interval, 0.37-1.38; P = .32). Compared with WLC patients, BLC patients were significantly more likely to receive intravesical Bacillus Calmette-Guerin (61% vs 43%; P < .01) or intravesical chemotherapy (48% vs 27%, P < .01). No difference in definitive treatment rates (radical cystectomy, radiation therapy, and/or systemic chemotherapy) was observed (8% vs 6%; P = .27) between BLC and WLC patients. Conclusions: In a high-risk NMIBC predominant cohort, the use of BLC was associated with reduced risk of bladder cancer recurrence. BLC use was also associated with increased use of intravesical therapies but not definitive treatment. These findings provide evidence for the oncologic benefits of using BLC.