Fluorescence Cystoscopy and Optimized MMC in Recurrent Bladder Cancer (FinnBladder 9)

Inclusion Criteria:

\- Primary papillary bladder cancer at high risk for further recurrence as defined as follows:

Number of primary tumors ≥2, OR Size of solitary primary tumor ≥ 3 cm, OR Recurrent papillary tumors

* Histologically proven Ta bladder cancer
* Histological grade 1-2 (WHO 1973 grading system) or papillary urothelial neoplasm of low malignant potential (PUNLMP) or low grade (WHO 2004 grading system) bladder cancer
* Written informed consent is required from every eligible patient

Exclusion Criteria:

* Grade 3 tumors (WHO 1973 grading system), or high grade tumors (WHO 2004 grading system)
* CIS (carcinoma in situ)
* Suspicion or evidence of papillary tumors or CIS of the upper urinary tract
* Non-TCC (transitional cell carcinoma, i.e. urothelial carcinoma) bladder cancer
* Suspicion or previous history of the patient not tolerating intravesical instillations
* Known allergy to MMC or hexaminolevulinate (HAL, Hexvix®)
* Urethral stricture, stone disease, chronic urinary tract infection or any other urological condition that may compromise study participation (as judged by treating physician)
* Pregnancy or lactating patient
* Other non-cured malignancy (excepting skin basalioma or cancer in situ of the cervix uteri or any other malignancy in remission ≥5 years)
* Age \< 18 years
* Expected survival time less than one year
* Expected poor compliance (e.g. some severe psychiatric disorders, antisocial behaviour, or dementia)