Urologic Cancer Care
Urologic oncology is the sub-specialty within urology that encompasses the evaluation and treatment of cancers. These include cancers of the male genito-urinary tract (i.e., kidney, renal pelvis, ureter, bladder, prostate, urethra, penis) and female urinary tract (i.e., kidney, renal pelvis, ureter, bladder, urethra) and adrenal glands in both male and female.
Our physicians offer highly specialized care in a supportive environment with attention to quality of life issues. Today, more than ever, the patient with a newly diagnosed cancer will have many therapeutic options. Depending upon the type of cancer, minimally invasive surgery may be the most appropriate option.
Prostate Cancer - Diagnosis and Treatment
Prostate cancer is the most common solid organ tumor in men in the United States. The rate of newly diagnosed prostate cancers has increased over the past 30 years, with a dramatic rise in incidence seen in the late 1980s following the introduction of serum PSA testing as part of prostate cancer screening.
The most appropriate treatment recommendation for men found to have prostate cancer is based upon the stage (extent of disease) at the time of diagnosis (i.e., cancer localized to prostate versus spread to other areas). Important variables to assess stage include:
- Serum PSA
- Biopsy Gleason Score
- Prostate MRI
- CT SCAN
- Bone Scan
This information allows the physician to most accurately discuss the available prostate cancer treatment options. Patients will want to discuss the options of robotic prostatectomy, dose escalated IMRT external beam radiation therapy, prostate brachytherapy (seed implant) and surveillance alone.
Bladder Cancer - Diagnosis and Treatment
Each year in the United States, approximately 54,000 new cases of bladder cancer are diagnosed. Bladder cancer is the fourth most common cancer in men, and eighth most common cancer in women. A number of factors have been associated with the development of bladder cancer. The most important is cigarette smoking. The etiology of bladder is considered to be multi-factorial.
The majority of bladder cancers are diagnosed as a result of evaluation of hematuria (blood in the urine). Some patients will present with frequency, dysuria and urgency. These symptoms of bladder cancer can mimic a urinary tract infection. Patients with hematuria or unexplained urinary symptoms should be evaluated for the presence of bladder cancer. Evaluation will often include a urinary cytology cancer cell check, kidney x-ray examination, and cystoscopy. Cystoscopy is the examination of the bladder using a small, flexible, fiberoptic endoscope.
The vast majority of bladder cancers are transitional cell carcinomas of differing grade and stage. Other types of cancers that occur in the bladder are squamous cell, adenocarcinoma and sarcoma (i.e., leiomyosarcoma). At the time of initial diagnosis, 75% of bladder cancer cases are superficial in nature and localized to the bladder. The remaining are more extensive at presentation. Patients usually undergo a procedure called "transurethral resection of bladder tumor." This allows removal of a bladder cancer specimen using specialized operative endoscopes in the operating room. Pathologic information gained from this initial procedure in addition to radiographic studies will allow the treating physician to initiate a discussion regarding the most appropriate treatment options and any necessary additional therapy. Treatments for bladder cancer are directed at bladder preservation, reduction of the recurrence rate, and in cases of need for extensive surgery, bladder replacement options.
Kidney Cancer - Diagnosis and Treatment
There are approximately 30,000 new cases of kidney cancer each year in the United States. The vast majority of kidney cancers arise in the renal cortex and are adenocarcinomas (renal cell carcinoma, hypernephroma). Approximately 80 to 85% of kidney adenocarcinomas are clear cell type, 10% are papillary, and the remainder comprise chromophobe and oncocytoma. Kidney tumors arising in the renal pelvis or collecting system are most often of the transitional cell carcinoma cell type.
Incidence rates of renal cancer have been rising in part due to an increase in discovery of small asymptomatic tumors during radiographic imaging for unrelated reasons. Less well understood, however, has been an upward trend in the detection of tumors at more advanced stages.
Clinical cancer stage will guide the most appropriate recommendation for therapy. In cases of cancer localized to the kidney, the recommended treatment is surgical. Options may include removal of the entire kidney, or an approach where the cancer and surrounding rim of kidney is removed and the remaining kidney left intact. This is referred to as partial nephrectomy, segmental nephrectomy or nephron-sparing surgery. There is increasing evidence that small kidney cancers can be managed safely with partial nephrectomy and renal preservation, and this procedure is now performed frequently by our physicians.
The kidney tumor may be removed through a standard open surgical incision, or in some cases laparoscopically utilizing minimally invasive techniques. In more advanced cases of renal cancer, either regional or distant, a multidisciplinary team is required to develop the most appropriate treatment plan. Such patients will benefit from presentation at a multidisciplinary working conference at which time all available options can be explored.
Testis Cancer - Diagnosis and Treatment
Testicular cancer is a rare malignancy; The American Cancer Society estimates that about 8,500 new cases will be diagnosed in the United States in 2012. Testis cancer is most common in males between the ages of 15 and 45 years. In men between 45 and 60 years incidence declines, and a new peak develops in men over the age of 60.
Approximately 90 to 95% of testis tumors are germ cell tumors, with the remainder being lymphoma and additional rare tumor types. Of the germ cell tumors, 60% are seminomas and the remainder are non-seminomatous in cell type histology. The tumor type is assigned by examining the excised testis tumor. Assessment of the extent of disease (staging) involves physical examination, measurement of serum tumor markers (AFP, HCG, LDH), and radiologic evaluation (CXR, CT scanning). Treatment for tetiscular cancer, following removal of the primary testicular tumor, will depend upon tumor histologic subtype and stage, and it may involve systemic chemotherapy, retroperitoneal surgery, radiation therapy, or close surveillance alone.