Bladder cancer (BCa) is the fourth most common cancer in men and one of the most common urinary tract cancers, especially in developed countries. The aim of this paper is to comprehensively analyze the biology of bladder cancer, including its epidemiology, etiology, histological types, risk factors, clinical symptoms, and diagnostic methods. The paper presents the dominant histological types of bladder cancer, such as transitional cell carcinoma (TCC), which accounts for 90–95% of cases, squamous cell carcinoma (SCC), and adenocarcinoma, which is much rarer. Risk factors, such as smoking, occupational exposure to chemicals, schistosomiasis, and genetic factors, which significantly affect the pathogenesis of bladder cancer, are also discussed. The paper focuses on modern diagnostic methods, including blue light cystoscopy (BLC) and computed tomography urography (CTU), which show increased sensitivity and specificity in detecting early neoplastic changes. The importance of TNM classification and the role of neoadjuvant chemotherapy in improving patient prognosis are also discussed. Based on a review of the scientific literature, the paper emphasizes the need for early diagnosis and an individualized therapeutic approach, which may contribute to improving the survival and quality of life of patients with bladder cancer. The potential for prevention, including quitting smoking and limiting exposure to harmful chemicals, has also been demonstrated to significantly reduce the risk of disease. Patient education and monitoring high-risk groups are key to reducing the incidence of bladder cancer.

Bladder cancer (BC) remains a clinical challenge due to its complex etiology and high incidence, especially in developed populations. This article presents a broad analysis of the latest advances in BC treatment, offering a new perspective on the growing role of innovative therapies that are effectively changing the standards of oncological care. Focusing on targeted therapy, immunotherapy, antibody–drug conjugates, and breakthrough gene therapies, the paper shows how modern approaches can counteract resistance mechanisms and improve treatment efficacy while limiting toxicity for patients. Progress in the field of immune therapies, including checkpoint inhibitors, offers hope for significant improvement in the outcomes of patients with advanced forms of cancer, and the concept of targeted therapy tailored to the molecular characteristics of the tumor indicates the potential of personalized oncology. Gene and photodynamic therapies, in turn, offer new possibilities for precise action on cancer cells, minimizing the side effects of traditional methods. The article presents innovative therapeutic strategies and results of the latest clinical trials, showing the prospects for the development of BC treatment and highlighting the key challenges facing oncology.

Background/Objectives: Non-muscle-invasive bladder cancer (NMIBC) accounts for the majority of newly diagnosed bladder cancers and is characterized by a high recurrence rate despite standard treatments. Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) offers a promising alternative; however, objective methods for monitoring therapeutic response are needed. Quantitative magnetic resonance imaging (MRI), particularly T1 and T2 relaxation mapping, may provide non-invasive biomarkers of tissue response to PDT. Methods: In this ex vivo study, 50 samples obtained during transurethral electro-resection of bladder tumors were analyzed using a 1.5 Tesla MRI scanner. Twenty-five healthy control tissues (n = 25) served as the control group. Twenty-five NMIBC tissues were analyzed twice: before and after 5-ALA-PDT. T1 and T2 relaxation times were measured, and regions of interest (ROIs) were manually segmented to obtain quantitative values. Statistical analyses were performed to assess the significance of differences observed between study groups. Results: T1 relaxation times significantly differed between groups: 1351.7 ± 271.1 ms in healthy tissue, 727.7 ± 145.0 ms in untreated NMIBC, and 368.9 ± 65.2 ms in NMIBC after PDT (p < 0.0001). T2 values were 93.5 ± 20.3 ms (healthy), 78.5 ± 20.4 ms (NMIBC), and 55.7 ± 6.1 ms (NMIBC_PDT), with significant reduction after PDT (p < 0.01). Conclusions: Quantitative T1 and T2 mapping via MRI is a sensitive and non-invasive method for detecting structural and biochemical changes in bladder tissue following 5-ALA-PDT. These relaxation times may serve as reliable biomarkers for therapeutic response, facilitating in real-time monitoring and personalized treatment planning for NMIBC. Further in vivo studies are warranted to validate these findings and integrate them into clinical practice.

Herein, we report a simple procedure regarding the photodynamic therapy (PDT) treatment as a minimally invasive modality for treating superficial bladder cancer that utilizes a photosensitizer, light, and oxygen to generate cytotoxic reactive oxygen species (ROS). This study evaluates the histopathological and morphological changes induced by PDT in an ex vivo model of low-grade (LG) pTa non-muscle-invasive bladder cancer (NMIBC). We investigated the efficacy of exogenous protoporphyrin IX (PpIX) and Rose Bengal (RB) by incubating tissue samples (n = 30) with an oxygen-saturated solution of PpIX (1–3 mM) or RB (0.3–0.5 mM) for one hour. Since the criticism of using frozen tissue in research already exists, this framing explains how to mitigate those limitations. Thus, we use oxygen-saturated solutions PpIX and oxygen-saturated solutions of RB. We discussed a few aspects related to the use of frozen tissue in PDT. Frozen tissue preserves lipids critical for assessing membrane damage and maintains higher levels of metabolic markers like antioxidant molecules like glutathione and more likely lack factors such as metabolic activity, intact cell membranes, and oxygenation. It is critical to differentiate between “artifactual” changes and the “pathological” death of cells. Thus, we used histopathological microscopy observation typically used in daily clinical investigations to characterize cells before and after PDT. Following irradiation with the light dose of 72 J/cm² (410 nm or 532 nm at 300 mW for 15 min), hematoxylin–eosin staining revealed concentration-dependent apoptotic changes, including chromatin condensation, pyknosis, and nuclear fragmentation. While both agents induced cell death, RB demonstrated faster and more intense cytotoxicity than PpIX. These findings provide microscopic evidence of PDT-induced tumor destruction and suggest that RB is a potent candidate for further preclinical evaluation. At 410 nm (deep blue/violet), light penetration in biological tissue is very shallow, typically only around 0.3 to 1 mm; therefore, in a 2 mm thick tissue sample, most of the light would be absorbed within the first millimeter, with minimal light reaching the full depth of tissues. In this protocol, the generated ROS is used to destroy tumor tissue by attacking the cellular microenvironment directly. This led to immediate membrane disruption and lipid peroxidation. The proof-of-concept is an early-stage study designed to verify that a PDT treatment is feasible, safe, and biologically active in an ex vivo model of LG pTa NMIBC.

Background/Objectives: Bladder cancer remains one of the most frequently diagnosed malignancies worldwide and is characterized by high recurrence rates requiring long-term surveillance. Conventional white-light cystoscopy (WLC) remains the standard diagnostic method; however, it may fail to detect flat lesions such as carcinoma in situ or small papillary tumors. In recent years, enhanced imaging techniques, including fluorescence cystoscopy and autofluorescence-based systems, have been introduced to improve diagnostic accuracy. The aim of this study is to evaluate the usefulness of fluorescence-based diagnostic techniques and autofluorescence imaging supported by numerical color value (NCV) analysis in the detection and assessment of bladder lesions. Methods: The study was conducted at the Center of Photodynamic Diagnostics and Therapy, Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia in Bytom. Bladder mucosa was assessed using the Onco-LIFE optical imaging system, which enables visualization under both white-light and autofluorescence conditions. The study included 30 patients diagnosed with non-muscle-invasive bladder cancer or suspected bladder lesions, who underwent cystoscopic evaluation using white-light cystoscopy and autofluorescence imaging. From this cohort, three representative cases were selected for detailed qualitative presentation to illustrate different pathological conditions of the bladder mucosa. In selected cases, photodynamic diagnosis (PDD) using intravesical administration of 5-aminolevulinic acid (ALA) was performed prior to cystoscopic examination. Autofluorescence signals were analyzed using red and green fluorescence channels, and tissue characteristics were evaluated using the numerical color value parameter. Results: Representative cases of non-muscle-invasive bladder lesions were analyzed and compared using conventional white-light cystoscopy and autofluorescence imaging. The use of fluorescence-based imaging enabled improved visualization of suspicious mucosal changes compared with standard WLC. Differences in fluorescence patterns were observed between malignant lesions, inflammatory changes, and carcinoma in situ. NCV analysis allowed quantitative assessment of fluorescence signals and supported differentiation of pathological tissue from normal bladder mucosa. Conclusions: Fluorescence cystoscopy and autofluorescence-based imaging systems represent valuable tools for improving the detection of bladder lesions during endoscopic examination. The integration of enhanced optical imaging techniques with quantitative fluorescence analysis may increase diagnostic sensitivity and support targeted biopsy and tumor resection. Continued technological development and clinical experience may further expand the role of fluorescence diagnostics in the early detection and management of bladder cancer.