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Monday Medical: Urological cancers

Susan Cunningham
For Steamboat Pilot & Today

Some of the most common cancers that affect Americans are those that take hold in or nearby the urinary and genital tracts.

“Kidney and bladder cancer are two of the most common cancers in both women and men, with prostate cancer being the No. 1 non-skin cancer in men,” said Dr. Clay Pendleton, a urologist in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “And testicular cancer is the most common cancer in men ages 20 to 40. These are more prevalent than people may think.”

Pendleton outlines what you need to know about these cancers below.

Prostate cancer

Men have a one in six chance of getting prostate cancer in their lifetime, and are most commonly affected from ages 55 to 75.

“Prostate cancer presents in multiple ways,” Pendleton said. “There are many slow-growing, low-grade tumors, but sometimes, men will be harboring a much more aggressive disease. And all along the spectrum of the disease, most patients are asymptomatic.”

Through Pendleton’s practice, which covers Summit, Eagle and Routt counties, about 150 men were diagnosed with prostate cancer last year. A third of those had an aggressive form of the cancer, and some of those were terminal diagnoses.

Regular screenings involving an annual exam and a PSA (prostate-specific antigen) blood draw are recommended for men ages 55 to 75. African American men and those with a family history of the disease may begin screening at the age of 40.

While the necessity of PSA tests has been debated, additional tests including the 4kscore test and prostate-dedicated MRIs, help make screenings more accurate and can decrease unnecessary biopsies.

If prostate cancer is found, there are various options for treatment.

“Treatment modalities have come a long way over the years,” Pendleton said. “Patients with low-grade cancer may just undergo active surveillance with periodic biopsies. Other patients may require chemotherapy, hormone therapy, radiation, cyroablation — or freezing of the prostate — or prostate removal through a minimally invasive surgery.”

Kidney and bladder cancer

These cancers are usually discovered because of the presence of blood in the urine, a condition known as hematuria.

“It is important for patients to know that it’s not common to have blood in your urine,” Pendleton said. “If you do, you need to be evaluated.”

A CT scan or kidney ultrasound can rule out kidney cancer. A quick, in-office procedure called a cystoscopy allows a doctor to look at the bladder with a camera to rule out bladder cancer.

“In the past, a lot of kidney tumors were discovered by actually feeling them, and by that point it was too late,” Pendleton said. “Now, they’re being found during hematuria workups and incidentally by CT scans and ultrasounds being utilized for investigation of other medical issues. For instance, I have had several kidney cancers discovered during MRI workups for back pain.”

Risk factors for both kidney and bladder cancer include a family history of the disease and a history of smoking or using smokeless tobacco. Additionally, exposure to certain chemicals and industrial dyes can also put patients at a higher risk.

Kidney cancer is typically treated with surgical removal, often in a minimally invasive manner, as these tumors are resistant to radiation and chemotherapy. Occasionally, smaller kidney tumors can be treated with cryoablation. With bladder cancer, a sample of bladder tissue is removed endoscopically to determine how aggressive the cancer is, then the cancer may simply be monitored if it is very low grade. More aggressive cancers often are treated with chemotherapy and bladder removal.

Testicular cancer

This cancer usually presents with a painless lump on the testicle and is confirmed by an examination and ultrasound.

If cancer is suspected, the testicle is typically removed and further imaging may be done.

“It’s a very curable cancer with a five-year cancer free-rate of over 92%,” Pendleton said. “However, sometimes it requires chemotherapy or radiation or a very extensive abdominal surgery. It’s important for men to perform self-exams periodically from ages 20 to 50 and to take any new lump or bump seriously.”

Risk factors include family history or having an undescended testicle at birth.

With all cancers, it’s best to catch the disease as early as possible.

“Sometimes, you see higher stage patients that have neglected a possible issue for some time, and it’s spread throughout their body,” Pendleton said. “It’s important to get an evaluation sooner rather than later for any concerns or abnormalities.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.


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