Urological: Key Points

Incidence: England & Wales

Prostate	16000 cases p.a.	Testis	1400 cases p.a.
Bladder	12000 cases p.a.	Penis	360 cases p.a.
Kidney	4400 cases p.a.

Prostate Cancer

• 99% of cases occur in men aged > 50 years

• About 25% of cases present in men aged < 70 years when life expectancy is > 10 years.

• Presenting features include raised prostate specific antigen (PSA), an abnormal rectal examination and bone pain.

• Lower urinary tract symptoms are common in the normal population of this age and are not a reason for suspecting prostate cancer.

• Early, potentially curable, prostatic cancers are either impalpable or have only a small nodule and a PSA that is generally less than 15ng/ml.

• The age specific upper limit of normal for PSA rises from 2.8 aged 50 up to 5.3 aged 70.

• Patients with a first degree relative with prostate or breast cancer are at higher risk of developing prostate cancer and Afro-Carribeans probably have an increased risk.

• PSA testing of asymptomatic men or screening for prostate cancer is not national policy. It is recommended that a PSA test, except in men clinically suspicious of prostate cancer should only be performed after full counselling and provision of written information.

Bladder/Urothelial Cancers

• 95% affect the bladder; 5% affect the upper tracts.

• 90% present with macroscopic haematuria.

• 5-10% present with microscopic haematuria.

• Both macroscopic and microscopic haematuria, when caused by a urothelial cancer are intermittent. Repeat urine testing can be negative for haematuria in the presence of a tumour.

• Urothelial cancer is more likely in patients with microscopic haematuria if they are males, over 50 years and smokers.

• Microscopic haematuria in patients under 40 years should be considered for referral to a nephrologist, especially if there is proteinuria, hypertension or renal impairment.

Kidney Cancer

• Macroscopic haematuria is the commonest presenting symptom.

• Other presenting features include loin pain, renal masses, microscopic haematuria, anaemia, weight loss and pyrexia.

• Renal cancers are increasingly found incidentally on abdominal imaging (e.g. CT or ultrasound).

Testis Cancer

• Scrotal swellings are relatively common in general practice.

• Solid swellings affecting the body of the testis have a high probability (> 50%) of being due to cancer.

• Indeterminate swellings of the testicle have a low probability of being due to cancer especially in men over 55 years and should be considered for ultrasound before urological referral.

• Swellings outside the body of the testis are hardly ever due to cancer and need not be referred urgently.