Urology >> Urological Cancer >> Screening & Diagnosis
Screening, Diagnosis and Treatment of Urological Cancer
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 frank bleeding into the urine, microscopic blood in the urine in patients 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 (on either side, regardless of surgical correction), a small testis, previous testis cancer or family history of testis cancer may increase the risk.
Diagnosis and Treatment
PROSTATE
Prostate cancer is invariably diagnosed by transrectal ultrasound guided prostate biopsy (See under investigations). 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 (see testosterone deficiency). 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.
Please refer to sections on
- Men’s Health
- Lifestyle
- Diet & Supplements
- Radical Prostatectomy
- Pfeiffer Protocol
- Testosterone Deficiency
- Evidence Based Medicine.
BLADDER
Bladder cancer is usually diagnosed by Cystoscopy (see Operations>cystoscopy). Pathological examination of the tumour tissue is always necessary, and this tissue is obtained by transurethral resection (see operations>transurethral resection of bladder tumour). For tumours that are non-invasive, resection may be sufficient treatment at the time, however there is a tendency to recur in the bladder and 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 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 (see photodynamic blue light cystoscopy). 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, as a solution instilled into the bladder. 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 (see radical cystectomy).
KIDNEY
Kidney cancer is invariably diagnosed by radiological investigation, and biopsy is unnecessary. 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, depending on the medical condition of the individual. Treatment will usually involve surgery, but there are some minimally invasive alternatives under investigation.
Please refer to sections on nephrectomy.
TESTIS
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.
Please refer to sections on radical orchidectomy.
