Male urology cancers

Prostate cancer is the most common male cancer in the UK with over 10 000 new diagnoses made yearly. It presents most commonly in older men. It is uncommon in men under the age of 50 years and may be suspected because of urinary symptoms or a raised prostate cancer blood test (Prostate Specific Antigen or PSA).

PSA is only produced by the prostate gland and is commonly raised in prostate cancer. It may also be raised in other non cancer related prostate conditions but if over the recommended age related level it represents a higher risk of prostate cancer. The prostate is situated near the rectum and is examined by placing a finger in the rectum. If the prostate feels firm or clearly nodular, a cancer may be suspected. A raised PSA or abnormal feeling prostate can represent a higher risk for prostate cancer.

Many men have PSA testing done via their GP if it is suspected. If a result is abnormal or the GP has examined the prostate and thought it may be abnormal men may be referred for assessment.

We will conduct a careful assessment to determine your risk of prostate cancer and from that determine whether to investigate further. These investigations may include repeating the PSA blood test, obtaining a multi-parametric MRI scan of the prostate, or performing a biopsy or sampling of the prostate. In some instances a PCA3 test can be useful. We can offer state of the art transperineal template biopsies of the prostate as well as the more standard trans-rectal biopsies of the prostate. The samples are then examined under a microscope by a specialist pathologist to see if there is harmless benign enlargement of the prostate or cancerous enlargement.

Not every man with prostate cancer requires treatment and in some cases active surveillance is appropriate. This means that the cancer is of low risk and rather than having a treatment with side effects, a close eye is kept on the prostate with regular PSA blood tests and periodic repeat biopsies. If the prostate cancer is one that requires treatment we will be able to guide you towards the best treatment options for you. We have close links with colleagues in London who carry out robotic radical prostatectomy surgery

Advanced prostate cancer is treated by switching off the male hormone, testosterone, thus removing the driver that makes prostate cancers grow. This can involve daily tablets or 3 monthly injections.

Testicular cancer is now highly curable due to treatments that combine surgery and for men with more severe disease on some occasions chemotherapy. Men who are suspected of having this condition usually see a urologist for blood tests and an ultrasound assessment is usually performed. If these suggest testicular cancer the tumour can usually be removed, often as single day surgery for early problems.

About 10,000 people a year in the UK get bladder cancer. It is more common in men than women and rare below the age of 50 years. Cigarette smoking is the biggest risk factor although often there does not appear to be any obvious cause. Transitional cell carcinoma is the commonest type of bladder cancer. Most cancers occur just on the lining on the inside of the bladder. Sometimes they grow deeper into the muscle of the bladder wall and become invasive in which case their management is more complicated. Carcinoma-in-situ is an aggressive type of bladder cancer that again occurs just on the surface but has a higher risk of becoming invasive if untreated.

How is Bladder Cancer Diagnosed?

If your GP is concerned, you will be referred to a urologist for further tests. A general assessment will be carried out, including a prostate check in men. Sometimes, your urine will be tested with a special NMP22 bladder check test immediately in the clinic- this test detects abnormal proteins in the urine and gives a good early indication that there might be a bladder cancer present. Usually blood tests are arranged including tests of kidney function and a PSA test. Scans of the kidneys are also arranged and the most important test is a cystoscopy. This is where a camera is inserted into the bladder and takes a few minutes but allows excellent views of the inside of the bladder.

How is Bladder Cancer Treated?

If a bladder cancer is discovered during the initial tests the next step will be to arrange an admission to Springfield Hospital or one of the hospitals in which we work, for an operation. Under a general anaesthetic ‘key hole’ techniques are used to pass an instrument through the urethra and scrape away the tumour with a hot wire loop. After the operation a catheter is required to drain the urine for one or two days until it clears. Specimens obtained are sent away for analysis to determine what sort of tumour was present and how deeply it has spread into the bladder wall. Most tumours are just on the surface lining of the inside of the bladder so this initial operation will cure the problem although they have a tendency to recur so regular follow up bladder checks will be required. Often a solution called Mitomycin is instilled into the bladder for an hour after the surgery to try and prevent these recurrences in the future.

What if the Cancer is more Advanced?

Cancers that appear to be more aggressive but haven’t put down roots– so called high grade G3pT1 or CIS- often require a course of weekly bladder instillations with a substance called BCG. This is put into the bladder with a temporary catheter and again needs to be retained for about 2 hours . Tumours that are found to invade deeply into the wall of the bladder will require further treatment either in the form of radiotherapy or surgery (a cystectomy) to remove the bladder (a cystectomy). A course of chemotherapy may be given first to shrink the tumour. If the bladder does have to be removed then the urine will be brought out into a bag that attaches to the skin of the abdomen (a urostomy). Alternatively a new bladder using the patient’s bowel can be constructed so that they can void the normal way after the operation (a bladder reconstruction or neobladder).

Kidney cancers are increasing in incidence due to improvements in and increased access to Ultrasound and CT scanning. They are more common in men than in women by a ratio of 2:1. The commonest age to present with the disease is between 60 and 80. People with a rare genetic condition called von Hippel Lindau disease develop tumours at an early age.

Treatment

The majority of kidney cancers are treated with surgery. Laproscopic (Keyhole) renal surgery is usually possible, but open radical nephrectomy (kidney removal) remains necessary in a number of cases. Treatment is dictated by a number of factors including age, other health problems, size of the tumour, number of tumours and the condition of the other kidney. Kidney sparing surgery (Partial Nephrectomy) is sometimes appropriate.

Tumours not amenable to partial nephrectomy, with a normal contralateral kidney may be treated with a laparoscopic radical nephrectomy or open radical nephrectomy if not suitable for key hole surgery. Small tumours may be removed from the kidney . Partial nephrectomy can be performed with a key hole technique but may require open surgery. Other options for small and occasionally multiple tumours, include cryotherapy (freezing of tumour) and radio frequency ablation (heating of tumour).

Often small incidentally found lesions in the elderly, may only require treatment if they become symptomatic. Blood in the urine can be dealt with by blocking the blood supply of the tumour, this is performed by imaging specialists called radiologists.

We are able to offer surgery locally for patients who require either removal of the kidney or part of the kidney (partial nephrectomy).  In some cases cryotherapy for small kidney cancers is an appropriate treatment and this can be offered locally as well.