Urologic oncology

Urologic oncology deals with the diagnosis and treatment of oncological diseases of the prostate, bladder, testicles, kidneys. Also of tumors of the adrenal gland, retroperitoneal tumors in soft tissue areas.

Diagnosis and treatment of prostate cancer

Prostate cancer is the second most common type of cancer in men. It mainly affects men over the age of 50, but for early diagnosis and treatment, it is recommended that annual screening starts after the age of 40.

Prostate cancer is often detected by screening (PSA or rectal swab tests) in men who have early stage disease and no symptoms or signs. If the PSA test or rectal exam indicates that prostate cancer may be occurring, more extensive monitoring and diagnostic testing is needed. Complaints may unfortunately occur at a later stage of development with the following picture:

• frequent urination
• weak or interrupted stream of urine or need for effort to empty the bladder
• blood in urine
• urgent need to urinate frequently at night
• blood in the seminal fluid
• onset of erectile dysfunction
• pain or burning during urination, which is less common
• discomfort when sitting caused by an enlarged prostate

Diagnosing prostate cancer:

• Screening: For this purpose, a digital rectal swab and a blood test to measure prostate specific antigen (PSA) levels are performed;
• Biomarker tests: Prostate cancer biomarker tests include the 4Kscore, which predicts a man's chances of developing high-risk prostate cancer, and the Prostate Health Index (PHI), which gives a prognosis for developing the disease;
• Prostate biopsy: For most cancers, a biopsy is the only sure way for the doctor to find out if there is a tumor in a particular area of the body. Patients with suspicious results and RSA values undergo a transrectal prostate biopsy under general anesthesia;

Treatments:

• Robotic or laparoscopic prostatectomy: Patients diagnosed with prostate pathology are treated by robotic or laparoscopic prostatectomy using the da Vinci robotic surgical system. In this way, the removal of the prostate gland and some of the surrounding tissue is as precise and patient-friendly a procedure as possible. This type of surgery is much less invasive than radical prostatectomy and the recovery time after it is shorter.
• Radical open surgery: Traditional surgery can be applied to patients who are not suitable for robotic surgery. It is the surgical removal of the entire prostate and seminal vesicles.
• Hormone therapy and radiation therapy: Lead to successful outcomes in patients with locally advanced prostate cancer or who are not suitable for surgery.

Diagnosis and treatment of bladder cancer

In this type of oncological condition, the first sign is blood in the urine. Most bladder cancers are diagnosed at an early stage, the most common symptoms or signs are:

• Blood or blood clots in the urine
• Pain or burning sensation when urinating
• Frequent urination
• Feeling the need to urinate many times throughout the night
• Feeling the need to urinate but not being able to urinate
• Pain in the lower back on one side of the body

Methods for the diagnosis of bladder cancer:

• Cytology. In cytology, random urine from normal urination is often used to find out if the urine contains tumor cells. The sample can be examined in different ways. The most common is by microscopic examination of the cells, called urine cytology. There are other urine tests that use molecular analysis and that can help detect cancer.
• Cystoscopy. In patients with blood in the urine, the bladder is examined for a tumor using cystoscopy. Cystoscopy is a modern method of diagnosing bladder tumors in which an internal view of the bladder is performed with a flexible, digital, lighted endoscope called a cystoscope. This brief procedure can detect tumor growth in the bladder and determine the need for biopsy or surgery.
• Transurethral resection of a bladder tumor. If a tumour is found during cystoscopy, a biopsy (removal of a small amount of tissue for examination under a microscope) is performed. This is a surgical procedure and is called transurethral bladder tumour resection. A transurethral resection is used to diagnose bladder cancer and to reveal the type of tumor and establish its depth in the layers. Transurethral resection can also be used as a treatment for muscle-invasive tumor.
• Computed tomography (CT or CAT): Creates a three-dimensional picture of the inside of the body using X-rays from different angles. The computer then combines these images into a detailed, cross-section that shows abnormalities or growths. The CT scan can also be used to determine the size of the tumor.
• Magnetic resonance imaging (MRI). MRI uses magnetic fields rather than X-rays to present detailed images of the body like a geographic map, also determines tumor size.
• Positron emission tomography (PET or PET-CT). Studies have shown that a PET scan can help detect bladder cancer that has spread with better accuracy than a CT or MRI. A PET scan is usually combined with a CT scan (see above) called a PET-CT.
• Ultrasound. Ultrasound uses sound waves to create a picture of the internal organs. This can help find out if the kidneys or ureters are blocked.

Treatments:

• Cystoscopy: According to the results of pathology, patients with tumors confined to the surface are checked once every 3 months using cystoscopy.
• Radical cystectomy: This is the removal of the entire bladder and often nearby tissues and organs. If muscle invasive bladder cancer is found as a result of pathological examinations, the pelvic lymph nodes may need to be removed and a new bladder made from the small bowel. Known as a radical cystectomy, this surgery can be done using robotic or open surgery.
• Transurethral tumor resection of the bladder (TU-TUR): This procedure is used for both diagnosis and staging as well as treatment. For patients with muscle-invasive bladder cancer, transurethral resection may be able to eliminate the cancer. However, the doctor may recommend additional treatments to reduce the risk of cancer recurrence, such as intravesical chemotherapy or immunotherapy.
• Chemotherapy: To prevent superficial bladder tumors, a one-time treatment with chemotherapy drugs in the bladder may be administered as additional treatment.
• Immunotherapy: Immunotherapy, also called biological therapy, is designed to stimulate the body's natural defenses to fight cancer. It uses substances produced by the body or in a laboratory to improve, target, or restore immune system function.
• Radiotherapy: Radiotherapy is the use of high-energy X-rays or other particles to destroy cancer cells. Radiotherapy is not usually used alone as a primary treatment for bladder cancer, but it can be used in combination with chemotherapy. A combination of radiation and chemotherapy can be used to treat cancer that is found only in the bladder. Patients who are not suitable for surgery should be treated with a combination of radiotherapy and chemotherapy.

Diagnosis and treatment of testicular cancer

Testicular tumors are seen in young men of reproductive age and can be treated at high rates with appropriate life-saving therapies.

Men with testicular cancer have different symptoms. Usually the first signs of testicular cancer are an enlarged testicle, a small lump or hardness in the testicular area.

Symptoms of testicular cancer may include:

• Lump or swelling of the testicle. If detected early, a testicular tumor can be the size of a pea, which grows significantly over time.
• Pain or discomfort, with or without swelling in the testicles or scrotum.
• A change in the way the testicle feels or a feeling of heaviness in the scrotum.
• Slight pain in the lower abdomen or groin.
• Sudden accumulation of fluid in the scrotum.
• Breast tenderness and/or growth.
• Back pain, shortness of breath, chest pain, bloody or purulent sputum can be symptoms of later stage testicular cancer.
• Swelling in one or both legs or shortness of breath due to thrombosis may be a symptom of testicular cancer. For some young or middle-aged men, developing pulmonary thromboembolism may be the first sign of testicular cancer.

Many of the symptoms of testicular cancer can also be due to non-cancerous diseases.

Methods for the diagnosis of testicular cancer:

• Screening. Screening is used to diagnose cancer before symptoms appear. Testicular cancer is often diagnosed at an early stage.
• Self-review. Many men discover it on their own while performing self-exams, and sometimes the sexual partner notices the change. Self-exams conducted after a warm shower can help diagnose testicular cancer early, when the likelihood of a successful cure is greater. Men who notice enlargement, the presence of a lump, hardening, pain or any other change in one or both testicles should see their doctor immediately.
• Ultrasound examination. The sonogram could determine the size, location, and firmness of the tumor. A solid tumor in the testicular area is very likely to be cancer.
• Tumor biomarkers. Serum tumor marker levels are tested prior to surgical removal of the testis. They are produced by the tumor or by the body in response to the carcinoma and are found in abnormally high levels in the blood of some patients. In testicular cancer, serum tumor marker levels are tested to determine the stage of the disease and to confirm whether the tumor is entirely seminoma.
• Biopsy. A biopsy is the taking of a small amount of tissue from an organ for examination under a microscope. Other tests can only suggest the presence of cancer, but only a biopsy can confirm the diagnosis with certainty.

Treatment:

• Inguinal orchiectomy: In case of suspicion of tumor in patients with testicular mass, surgical operation is immediately planned and testicle with tumor is immediately removed by inguinal orchiectomy. The whole body is then scanned with computed tomography (CT). Serum levels of BHCG, AFP and LDH are used as tumor markers during follow-up. Since testicular tumors have different behaviors according to their pathological structures, monitoring and treatment approaches are determined specifically for each patient case.
• Reperoperitoneal lymph node dissection (RPLND): In patients with metastases to the lymph nodes surrounding the aorta and superior vena cava in the retroperitoneal space, these tumor tissues are completely removed by lymph node dissection.
• Chemotherapy and radiotherapy: According to the results of pathological tests, patients may need to take additional chemotherapy and radiotherapy.

Diagnosis and treatment of kidney cancer

This disease rarely develops in people under 45. The average age of those affected is 64 years. However, trends show that the number of registered renal cell carcinoma tumours in the country is increasing.

Often, kidney cancer is discovered accidentally when a person has an X-ray or ultrasound for some other reason. In the early stages, the disease does not cause pain. Symptoms usually appear when the tumor grows and begins to affect nearby organs.

Symptoms of kidney cancer may include:

• Blood in urine
• Pain with pressure on the side of the body or in the back
• A mass, growth or lump on the side or back of the sacrum
• Swelling, edema of the ankles and feet
• High blood pressure
• Anemia associated with low red blood cell count
• Fatigue
• Loss of appetite
• Unexplained weight loss
• Recurrent fever that is not caused by a cold, flu or other infection
• In men - the presence of varicocele, which is a rapid growth of a group of varicose veins around the testicles, especially for the right testicle, may indicate the presence of a large renal tumor

Some of the symptoms listed also occur in other kidney diseases.

Methods for the diagnosis of kidney cancer:

• Physical examination by a doctor.
• Blood and urine tests. These tests check the red blood cell count and the presence of blood in the urine, bacteria or cancer cells in it. These tests can indicate the presence of kidney cancer, but cannot be used to make an accurate diagnosis.
• Biopsy. It is usually performed by an interventional radiologist as an outpatient procedure, using local anesthesia.
• Imaging studies. Computed tomography (CT or CAT scan), X-ray, Magnetic resonance imaging (MRI), Intravenous pyelography (IVP) (the so-called colour picture of the kidney), Cytoscopy and nephro-ureteroscopy.

Treatment:

• Radical nephrectomy. The operation to remove the tumour, the whole kidney and surrounding tissue is called a radical nephrectomy. Radical nephrectomy is most often used as a treatment for a large tumor when there is less healthy tissue.
• Partial nephrectomy. Partial nephrectomy consists in the surgical removal of a tumor. This type of surgery preserves kidney function and reduces the risk of developing chronic kidney disease after it. Studies have shown that partial nephrectomy is effective for stage T1 tumors.
• Laparoscopic and robotic surgery (minimally invasive surgery). During laparoscopic surgery, the surgeon makes several small incisions instead of 1 larger one in the abdomen used during the traditional surgical procedure. The surgeon then inserts telescoping instruments into these small keyhole-sized holes to remove the affected kidney or perform a partial nephrectomy. Sometimes the surgeon may use robotic equipment to perform the surgery. This can make the manipulation longer in duration but less painful.
• Radiofrequency ablation. It was used only for patients who were in poor health and surgery was not possible.
• Cryoablation. Cryoablation, also called cryotherapy or cryosurgery, is a method of treatment in which cancer cells are humiliated by freezing using a metal probe.
• Antiangiogenesis. This type of treatment is aimed at stopping the process of creating new blood vessels. Because the tumor needs nutrients supplied by the blood vessels to develop and spread, the goal of antiangiogenesis therapy is to let it "starve."
• Chemotherapy and radiotherapy.

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