Uro Oncology - Dr. Vikram U. Deshmukh

Uro oncology is a branch of urology that deals with management of malignancies of the genitor-urinary tract like that of the kidney, ureter, bladder, prostate, penis & testis.

The treatment of urological cancers depends on the stage of the disease at presentation. Surgery still remains as the predominant form of treatment. However the recent advances have resulted in introduction of minimally invasive and less morbid treatment options. In renal cancers (Fig. 1), nephron sparing surgery is now the norm for small tumors. Majority of the urinary bladder tumors (Fig. 2) are non invasive and can be managed with endoscopic surgery ie. TURBT. However in cases of advanced malignancy of the kidney or bladder, radical surgery is still required.

Fig.1. Renal Cancer

Fig.2. Urinary Bladder Tumour

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Prostate Cancer

Prostate cancer is the 2 nd most common malignancy in men. This is a disease of old age and 63% of the cases are diagnosed after the age of 65 years. These patients may present with obstructive lower urinary tract symptoms (LUTS) like poor stream of urine, straining at micturition, hematuria etc. As prostate cancer spreads to the bones, some patients may present with backache or bony pains.

In India, majority of the patients of prostate cancers are still diagnosed at a late stage where curative treatment is not possible. Screening can help in early diagnosis. For screening, digital rectal examination and a blood test (ie. Sr PSA) is required. If diagnosed in early stage, surgery can be curative. Radiation therapy, for early prostate cancer, has also emerged as an optional competitive treatment.

If the cancer has spread to the bones (metastasis) then curative treatment is not possible but in majority of such patients survival can be increased with proper treatment. Castration (surgical/medical) is the initial treatment in such cases. Eventually all of these patients reach a castrate resistant stage where the cancer again starts spreading. In Castration Resistant Prostate Cancer (CRPC) other systemic treatments (eg Aberaterone/Chemotherapy) are required and help to prolong survival.

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Fig.3. Prostate Cancer

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Penile Cancer

These cancers occur in older men and present with a small pustule, papule or growth over the penis. In 80% of the cases the growth is present on the distal aspect of the penis ie on the glans or prepuce. Phimosis and poor hygiene are major risk factors for developing penile cancer. Delay is seeking treatment is common. Surgery, in the form of partial or total Penectomy with or without groin node dissection is the standard treatment option.

Fig.4. Penile Cancer

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Testicular tumors

Most commonly present as a painless testicular mass. In late cases due to the spread of cancer the patient may present with a mass in the abdomen or in left side of the neck. In one third of the cases these tumors are misdiagnosed as epididymitis or hydrocele. A scrotal ultrasound and blood tests (AFP, LDH, hCG) help in reaching the diagnosis. Removal of the affected testis (orchiectomy) is required for confirmation of the diagnosis. Depending on the stage of the disease additional treatment may be required. Effective combination chemotherapy have brought testicular cancers even when advanced, under the purview of potentially curative tumors.

ser — Fig.5. Testicular Tumors

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Today, the treatment for malignancies of the genito-urinary tract is based on the evidence of randomized controlled multicentre trials which have statistical validity. This has enabled the formulation of treatment guidelines so as to give the best survival benifit.

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