Urological cancers other than testis cancer are rare under the age of 40 years, but unfortunately, one can never say never. See Screening and Diagnosis of Urological Cancer
Prostate cancer only affects men and is the commonest non-cutaneous cancer in men, and second commonest cause of cancer death after lung cancer). It commonly presents after a PSA test done as part of the investigation of urological symptoms, or as a screening test. Occasionally, it can present at an advanced stage, particularly in men who have not had a PSA test for several years.
Bladder cancer is about three times more common in men than women. It is the fourth commonest cancer in men and eighth commonest cancer in women. It tends to present with blood in the urine or new bladder symptoms, and can sometimes mimic urinary infection or cystitis.
Kidney cancer is the third most common urological cancer. Like other urological cancers, it is more common in men than women. It tends to present itself as an unexpected finding when having an investigation that images the kidneys and other internal organs. It can also present with haematuria or flank pain. See nephrectomy (includes radical nephrectomy, partial nephrectomy, ablation of renal masses.
Testis cancer is most common in young men (post-puberty to 40 years), but can affect older men. It is generally detected by the man noticing a swelling within or on the testis, and is usually painless. See radical orchidectomy.
Screening and Early Detection
- Prostate cancer can be detected early with PSA testing, and treated. Symptoms are an unreliable indicator for detecting prostate cancer. PSA is a blood test and elevated levels may indicate prostate cancer in its early stages. Unfortunately, PSA is also elevated in many men with benign prostate disease (Benign Prostatic Hyperplasia or Prostatitis). Other tests with greater specificity for prostate cancer include free PSA (a blood test) and PCA-3 (a urine test). The risk of prostate cancer is increased by a family history.
There are no screening programs for bladder cancer. However bladder cancer should be ruled out when there is visible blood in the urine, microscopic blood in the urine in men and women over the age of 40 years or unexplained bladder symptoms. Although some urine tests are available for detecting cancerous cells in the urine, these are not as reliable as cystoscopy for diagnosis of bladder cancer. The most common risk factor for developing bladder cancer is smoking. Family history of bladder cancer does not increase the risk.
There are no screening programs for kidney cancer, however it is frequently picked up incidentally on ultrasound and CT scans done for non-urological reasons. Kidney cancer may be detected on investigation of blood in the urine, pain in the flank or presumed kidney infection. In its very early stages, it is difficult to distinguish a kidney tumour from a benign (non-cancerous) renal tumour, and up to 50% of small kidney masses less than 2.5 cm diameter may be benign. Family history may increase the risk of some types of kidney cancer. Renal dialysis (with kidney failure) also increases the risk, but most tumours develop sporadically.
Testis cancer almost always presents with a testicular mass, noticed by the individual or his partner. Testicular swelling should always be investigated urgently - and it is usually straightforward for a specialist to rule out cancer. Congenital undescended testis, regardless of surgical correction, a small testis, previous testis cancer or family history of testis cancer may increase the risk.
For further advice on urological cancer or PSA testing, please call us on +44 (0)207 487 5398 to book an appointment, with Mr. Mark Feneley at The Consulting Rooms, 103 Harley Street, Suite 8, 3rd Floor, London, W1G 6AJ.
- Prostate cancer is invariably diagnosed by transrectal ultrasound guided prostate biopsy. Biopsies are carried out following an abnormal PSA test. PSA tests are carried out as part of the investigation of urinary symptoms in men, and for prostate cancer screening (see above).
Treatment of prostate cancer depends on the cell type, stage and grade of the cancer. In its early stages, prostate cancer can be cured by a variety of standard treatments including radical prostatectomy, radiotherapy or brachytherapy. Radiotherapy and brachytherapy invariably require testosterone suppression, sometimes for a prolonged period, which is not necessary with radical prostatectomy.
In some (usually older) men, screening for prostate cancer may identify a tumour too early, and immediate treatment (with attendant recovery and long-term side effects) may not be necessary. In these cases, careful surveillance with a view to later treatment (if required) may be an equivalent option.
For further advice on prostate cancer or prostate cancer treatments, please call us on +44 (0)207 487 5398 to book an appointment, with Mr. Mark Feneley at The Consulting Rooms, 103 Harley Street, Suite 8, 3rd Floor, London, W1G 6AJ.
- Bladder cancer is usually diagnosed by Cystoscopy. Pathological examination of the tumour tissue is always necessary, and this tissue is obtained by transurethral resection. For tumours that are non-invasive, resection may be sufficient treatment at the time, however there is a tendency for subsequent tumours to develop in the bladder and sometimes in other parts of the urinary tract lining. Around 20% of bladder tumours extend more deeply into the bladder wall, sometimes without serious symptoms. Muscle-invasion indicates that the tumour may be life-threatening, and radical treatment is then usually required.
Photodynamic “blue light” cystoscopy improves the detection and assessment of non-invasive bladder cancer, and is particularly useful for assessing the more aggressive tumours. Some non-invasive tumours have a strong tendency to recur, and the most aggressive of these bring the very real risk of becoming muscle-invasive. To reduce these risks, additional treatment can be given after the tumour has been cleared surgically. This is done with a solution instilled into the bladder for 1 - 2 hours, through a catheter in the urethra.
Solutions most commonly used contain either Mitomycin C (MMC), or Bacille Calmette Guerin (BCG). MMC is a form of local chemotherapy, it has a very low side effect profile, and it can be given after transurethral resection to reduce recurrence rates. BCG tends to cause more side effects but is more active against the more aggressive tumours. Either MMC or BCG can be given as a course of weekly treatments for 6-8 weeks. Using Electromotive Drug Administration ™ (http://physion.com/), the penetration of MMC through the bladder lining is enhanced, and treatment response may be improved.
Electromotive MMC can also be used in combination with BCG. Tumours that are resistant to these measures or have already invaded the muscle layer of the bladder require more definitive treatment such as radical cystectomy or radiotherapy.
For further advice on bladder cancer including screening, diagnosis and treatment, please call us on +44 (0)207 487 5398 to book an appointment, with Mr. Mark Feneley at The Consulting Rooms, 103 Harley Street, Suite 8, 3rd Floor, London, W1G 6AJ.
- Kidney cancer is invariably diagnosed by radiological investigation, and treatment does not usually require biopsy. Usually a radiological diagnosis of cancer is correct, but occasionally there may be uncertainty – particularly with smaller tumours less than 2.5 cm diameter. Once a tumour reaches 2.5 to 3 cm diameter, the benefit of treatment begins to outweigh the risks of the disease and potential complications of its treatment, depending on the medical condition of the individual. Treatment will usually involve surgery, but there are some minimally invasive alternatives under investigation.
For further advice on kidney cancer including screening, diagnosis and treatment, please call us on +44 (0)207 487 5398 to book an appointment, with Mr. Mark Feneley at The Consulting Rooms, 103 Harley Street, Suite 8, 3rd Floor, London, W1G 6AJ.
- Testis cancer usually develops in adult men under 40 years of age, but occasionally in older men. Pain is often NOT present, however it certainly does not exclude the possibility of cancer. Testicular cancer should be diagnosed early owing to its tendency to grow rapidly and spread. The majority of testis cancers are now cured with modern treatment and follow-up surveillance.
For further advice on testicular problems including cancer, please call us on +44 (0)207 487 5398 to book an appointment, with Mr. Mark Feneley at The Consulting Rooms, 103 Harley Street, Suite 8, 3rd Floor, London, W1G 6AJ.
Tumour TypesA organ can give rise to various tumour types, according to the cell type of origin. The cell type may influence treatment options, and prognosis. The cell type is determined by pathological examination of biopsy material.
Tumour StagingTumour stage describes the extent to which a tumour has invaded from its origin. A tumour first invades within the organ of origin (prostate, bladder or kidney etc). It may then extend beyond the organ into adjacent surrounding tissues or adjacent organs. The extent of the primary tumour is described by a “T” stage category (e.g. T1, T2, T3, T4), and the meaning of the code is specific for the organ of origin. Cancerous cells may jump to other parts of the body (when it is then called a Metastasis). This may be local lymph glands (assigned a “N” category, or more distant tissues, most commonly bone, lung, liver (“M” category). The extent of the spread can usually be determined X-rays, CT scan, and bone scan.
Grading of Urological CancerTumours are graded from tissue biopsies by pathologists. The grade describes the microscopic appearances of the tumour and relates to their biological behaviour. Grading is most important for tumours that have not yet spread, rather than tumours that have been seen to have spread by tumour staging investigations.
As a general rule, lower numbers for tumour grade indicate less aggressive tumours and better prognosis. Prostate cancer is graded by Gleason Grade, consisting of two numbers each between 1 and 5 that are added together to give a “Gleason Sum Score” (between 2 and 10, e.g.”3+4”). Bladder cancer is graded from 1 – 3. Kidney cancer is graded by Fuhrman Grade (1-4).