Urological Oncology

UROLOGICAL ONCOLOGY

It is the sub specialty of Urology that deals with cancers affecting the urinary tract or male reproductive organs. These include cancer of kidney, adrenal gland, ureter, bladder, prostate, urethra, penis and testis. Our centre offer comprehensive management of these cancers. A patient who presents with symptoms or signs suggestive of a urological cancer should be referred to a team specializing in the management of urological cancers.

Dr. Praveen Pandey has special interest in Uro-oncology. He is well trained in India and abroad in managing such conditions. He has enormous experience in treating urological cancers.


PROSTATE CANCER

Prostate cancer is a possibility in male patients with any of the following unexplained symptoms

  • Haematuria
  • Lower urinary tract symptoms
  • Lower back pain/li>
  • Bone pain
  • Weight loss, especially in the elderly

Prostate cancer is the commonest cancer in men in both America and Europe. In India, it is the fastest increasing cancer with the latest survey showing it to be the second most common cancer in Indian men.


These patients should also be offered a DRE and a PSA test. Urinary infection should be excluded before PSA testing, especially in men presenting with lower tract symptoms. The PSA test should be postponed for at least 1 month after treatment of a proven urinary infection. If a hard, irregular prostate typical of a prostate carcinoma is felt on rectal examination, then the patient should be referred urgently a Urologist. The PSA should be measured and the result should accompany the referral. Patients do not need urgent referral if the prostate is simply enlarged and the PSA is in the age-specific reference range. In a male a patient with or without lower urinary tract symptoms and in whom the prostate is normal on DRE but the age-specific PSA is raised or rising, an urgent referral should be made.

In those patients whose clinical state is compromised by other comorbidities, a discussion with the patient or caretakers and/or a specialist in urological cancer may be more appropriate. Symptomatic patients with high PSA levels should be referred urgently. If there is doubt about whether to refer an asymptomatic male with a borderline level of PSA, the PSA test should be repeated after an interval of 1 to 3 months. If the second test indicates that the PSA level is rising, the patient should be referred urgently.

BLADDER AND RENAL CANCERS

Male or female adult patients of any age who present with painless haematuria should be referred urgently. In male or female patients with symptoms suggestive of a urinary infection who also present with macroscopic haematuria, investigations should be undertaken to diagnose and treat the infection before consideration of referral. If infection is not confirmed, the patient should be referred urgently. In all adult patients aged 40 years and older who present with recurrent or persistent urinary tract infection associated with haematuria, an urgent referral should be made.

In patients aged 50 years and older who are found to have unexplained microscopic hematuria(seen only on urine testing), an urgent referral should be made. Any patient with an abdominal mass identified clinically or on imaging that is thought to be arising from the urinary tract should be referred urgently.

Kidney cancer is on the rise with incidence doubling in the last 35 years in India. Both kidney and bladder cancers are much more common in men than women. Bladder cancer is also one of the ten most common cancers in India, having a strong association with smoking and aging.

TESTICULAR CANCER

Any patient with a swelling or mass in the body of the testis should be referred urgently. An urgent ultrasound should be considered in men with a scrotal mass that does not trans illuminate and/or when the body of the testis cannot be distinguished.

Testis cancer is less common but affects younger men. In fact, it is the most common cancer in a man between the ages of 17 to 34 years old.

PENILE CANCER

An urgent referral should be made for any patient presenting with symptoms or signs of penile cancer. These include progressive ulceration or a mass in the glans or prepuce particularly. But can involve the skin of the penile shaft. Lumps within the corpora cavernosa not involving penile skin are usually not cancer but indicate Peyronies disease, which does not require urgent referral.

TREATMENT

Treatment of Uro-oncology conditions have improved dramatically in the last decade. Many cancers are diagnosed in the early stage and surgical removal of the organ or part of the organ has given the patient a chance of cure. Surgical techniques have improved with the advancement in laparoscopy surgery(key hole surgery),endoscopy surgery (scope surgery without a surgical cut) and robotic assisted surgery. Hence, surgical outcomes are much better; causes less pain and quicker recovery for the patient. As a result of extensive medical research, we have a better understanding of cancer behavior and are able to fine tune our treatment to each cancer, giving the optimal result. This has necessitated the close collaboration between the urologist (urology surgeon and usually the main doctor),medical oncologist and radiation oncologist.

Cancers with previously poor outcomes have been successfully treated with a combination of planned surgery followed by chemotherapy or radiation. We emphasizes not only on the treatment but also on recovery strategies for our patients suffering from such conditions.

Urological cancer surgeries performed by Dr. Praveen Pandey:

a. Radical nephrectomy (Laparoscopic/open)

b. Partial nephrectomy (Laparoscopic/open)

c. Radical prostatectomy (Laparoscopic/open)

d. Nephro-uretrectomy (Laparoscopic/open)

e. Radical cystectomy (Laparoscopic/open)

f. High inguinal orchiectomy

g. Partial or total penectomy

h. Adrenalectomy (Laparoscopic/open)

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