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To evaluate, in a long-term follow-up of T1 high-grade bladder cancer treated in a prospective, randomized trial, whether fluorescence diagnosis (FD) increases recurrence-free survival (RFS) or reduces progression to muscle-invasive stages.In all, 191 patients with suspected superficial bladder cancer were treated with transurethral resection under white light (WL) or with FD; 46 presented with initial T1 high-grade BC (WL, 25; FD, 21). There were no differences in multifocality of tumours, concomitant carcinoma in situ or tumour size in either group.Patients were followed for a median of 7.3 (WL) and 7.5 (FD) years to evaluate RFS. In the WL group there were 11, and in the FD group three, recurrent tumours of the same stage and grade. The RFS at 4 and 8 years was 69% and 52% in the WL, and 91% and 80% in FD group, respectively. With FD, the RFS was significantly longer according to Kaplan-Meier analysis (P = 0.025). In the WL group, three (12%), and in the FD group four (19%) patients progressed to muscle-invasive stages (≥ T2).In initial T1 high-grade bladder cancer, FD is significantly better than conventional WL transurethral resection for RFS. However, the progression rate to muscle-invasive disease was not reduced by FD. Thus the clinical course (progression) of T1 high-grade bladder cancer remains unaffected by FD.