Urologic Cancers
Prostate Cancer
Prostate cancer forms in the tissue of the prostate gland which is approximately the size of a walnut and found below the bladder and in front of the rectum. There are approximately 250,000 new cases each year with approximately 35,000 patients dying of the disease annually. Prostate cancer is the third most common cause of death from cancer in men of all ages and the most common cause of death in men over the age of 75.
Known risks for prostate cancer include race with African-American men being more likely to develop prostate cancer. Another risk factor is age, men who are older than 60 are at increased risk. Family history is also a risk factor, in particular patients with a father or brother diagnosed with prostate cancer.
Most patients with prostate cancer have no definitive symptoms when it is caught at early stages. Testing for prostate cancer includes an annual prostate specific antigen test (PSA) as well as a digital rectal exam to assess the prostate.
Some signs of advancing prostate cancer are also signs of benign growth within the prostate gland including: weakened urinary stream, difficulty evacuating the bladder, blood in urine or semen, and pelvic pain or bone pain once the disease has progressed.
There are multiple treatment options for prostate cancer which are best discussed with your urologist. However, these can include observation, hormonal ablation, cryosurgery, chemotherapies, high intensity focused ultrasound (HIFU), external beam radiation therapy, prostate seed implant, radical prostate surgery including: traditional surgery, laparoscopic surgery as well as da Vinci robotic-assisted prostatectomy, occasionally requiring removal of lymph nodes as well.
Kidney Cancer
The most common type of kidney cancer in adults is renal cell carcinoma primarily diagnosed between the ages of 50 and 70 years of age with no exact cause identified. Some factors can increase the risks of kidney cancer including: dialysis treatment for kidney failure, family history of renal cell carcinoma, high blood pressure, congenital abnormalities of the kidneys, polycystic kidney disease, and smoking.
Although most kidney cancers are found incidentally on radiologic imaging for other reasons, kidney cancers can include some symptoms such as abdominal pain, flank pain, blood in the urine, weight loss, and constipation.
Radiologic imaging can easily diagnose most kidney tumors including renal ultrasound or abdominal CT scan traditionally performed to evaluate the kidney as well as MRI’s and multiple other radiologic imaging.
Treatment for kidney cancer typically includes removal of the kidney which was performed in the past using open surgical techniques and currently more commonly using laparoscopic or da Vinci robotic-assisted techniques to remove either the entire kidney or a portion of the kidney.
Most chemotherapy agents will not cure the cancer although it may decrease its growth once the tumor has spread.
Bladder Cancer
While several types of bladder cancer can develop, the most common type in the United States is transitional cell carcinoma of the bladder which often starts as small papillary tumors within the bladder, although less commonly it can be sessile or flat appearing lesions within the bladder.
There are several risk factors that are known to increase the incidence of bladder cancer including cigarette smoking and other tobacco products as well as chemical exposure, chemotherapies, radiation treatments as well as chronic infection or indwelling catheters.
The typical signs of bladder cancer can include blood in the urine, irritative urinary symptoms including voiding frequently and urgently, incontinence, as well as lower abdominal pain and weight loss.
Bladder cancer is commonly diagnosed by cystoscopy which includes visualizing the bladder with a telescope performed in the office as well as x-ray imaging with CT scans or other x-rays using contrast such as IVP as well as urine cytologies which evaluate the urine for abnormal cells which have been passed.
Treatment options include removing the bladder tumor through telescopes placed into the bladder, chemotherapy agents which are placed into the bladder or if advanced it may require surgical removal of the bladder by traditional surgery, laparoscopic techniques, or da Vinci robotic-assisted techniques with alternative drainage of urine into small segment of bowel or a newly developed bladder pouch. There is also partial removal of the bladder, radiation therapy and chemotherapy which are alternative options for advanced disease as well as immunotherapy.
Testicular Cancer
Testicular Cancer occurs most frequently in men between the ages of 15 and 35, although it can occur in older men as well. Rare types of tumors can develop in extremely younger men as well as those of advanced age. Race also plays a part in testicular cancer as Caucasians are more likely to develop the disease than African Americans and Asian Americans.
There are two general categories of tumors including seminomas and non-seminomas. Risk factors include abnormal testicular development, history of testicular cancer, undescended testicles and congenital abnormalities.
The symptoms typically include pain in the testicle or scrotum, a testicular mass which is easily palpable or enlargement of the testicle, weight loss, and back pain. Evaluation typically includes physical examination, scrotal ultrasound, further x-rays to assess for any progression of the disease as well as blood tests which are used as tumor markers including alpha-fetoprotein and chorionic gonadotropin.
Treatment options typically include removal of the affected testicle to assess the type of tumor as well as follow up radiologic imaging and blood testing to assess as to whether the disease has progressed. Further treatment may be necessary including possible radiation therapy or chemotherapy and becoming more popular is observation with careful follow with radiologic imaging to be sure that the disease is not recurrent in both that have been treated with chemotherapy and radiation as well as those that are simply being followed after removal of the testicle alone. The disease can progress into the lymph nodes and other parts of the abdomen as well as lungs, spine and brain with advanced disease. The prognosis in patients even with advanced disease oftentimes is quite good.
