Urological Cancers

Urological cancers are a group of cancers that affect the urinary system and, in men, the reproductive organs. The term covers five main types: bladder, kidney, prostate, testicular and penile cancer.

What are the symptoms of urological cancers?

Symptoms vary depending on which organ is affected, but some signs are worth getting checked across several of these cancers, including:

• blood in your urine, even if it's a one-off and doesn't hurt
• a change in how you pass urine, such as needing to go more often (especially at night), or a weak or hesitant flow
• a lump or swelling in a testicle, or any change in its size, shape or texture
• changes to the skin of the penis, such as a lump, sore, or change in colour
• unexplained weight loss, tiredness, or loss of appetite.

Many of these symptoms have a more common, non-cancerous cause, such as a urine infection or an enlarged prostate, but they should always be checked by a doctor.

What are the causes of urological cancers and who is at risk?

The causes vary by cancer type, and for some cancers, such as testicular cancer, it's often not clear why it develops. Where risk factors are better understood, they include:

• smoking, which is the most significant modifiable risk factor for bladder cancer and can increase the risk considerably
• long-term exposure to certain industrial chemicals, such as those used in dye, paint, rubber and petroleum industries, which is linked to a higher risk of bladder cancer
• being over 65, since bladder cancer is much more common in older adults
• a family history of prostate cancer, along with ethnicity and increasing age
• not being circumcised, which is linked to a higher risk of penile cancer, most cases of which develop under the foreskin.

Bladder cancer is also around four times more common in men than in women.

Are there different types of urological cancer?

Yes. The five recognised types are grouped by the organ they start in, and each behaves quite differently.

Prostate cancer starts in the prostate gland, a walnut-sized gland at the base of the bladder. It's the most common cancer in men in the UK, and its diagnosis rate has been rising, largely because more cases are now being picked up. Trans women and non-binary people with male reproductive organs can also develop prostate cancer.

Bladder cancer most often starts in the cells lining the bladder. Around 9 in 10 cases are what's known as transitional cell (urothelial) carcinoma. A less common form linked to certain parasitic infections and repeated urine infections is squamous cell carcinoma. It commonly causes blood in the urine, which usually means it's picked up at an early stage, when it can often be diagnosed quickly using a flexible camera passed into the bladder (a cystoscopy).

Kidney cancer (also called renal cancer) starts in the kidneys, the two bean-shaped organs, each about the size of a fist, that filter waste from your blood into urine. If it spreads elsewhere in the body, it's described as advanced or metastatic.

Testicular cancer develops when abnormal cells in a testicle divide and grow in an uncontrolled way. It's the most common cancer in men aged between 20 and 50, but treatment is highly successful, and the outlook is generally very good for most patients, even when the cancer has spread elsewhere in the body.

Penile cancer is a rare cancer in the UK that develops when abnormal cells grow uncontrollably in the skin or tissue of the penis. It can occur anywhere on the penis, but is most common under the foreskin in men who haven't been circumcised, or on the head of the penis.

How are urological cancers diagnosed?

Your GP will usually start with a physical examination and some initial tests, such as a urine sample and blood tests. What happens next depends on which cancer is suspected:

• for suspected bladder or kidney cancer, this usually involves a scan, such as an ultrasound or CT scan, and a cystoscopy, where a thin camera is passed into the bladder to look for anything abnormal
• for suspected prostate cancer, this usually involves a blood test called a PSA test, an MRI of the prostate gland along with a physical examination of the prostate
• for suspected testicular cancer, an ultrasound scan of the testicle is usually the first step.

If a suspicious area is found, a small sample of tissue (a biopsy) is usually taken and examined under a microscope to confirm the diagnosis and help plan your treatment.

How are urological cancers treated?

Treatment depends on which cancer you have, its size and location, whether it has spread, and your general health. Your care will usually be planned by a team of specialists working together, including urologists, oncologists and specialist nurses.

Surgical treatment often forms part of the plan, and may include:

• removing a bladder tumour through the urethra using a telescope (a procedure called TURBT), which is often enough on its own for early bladder cancers
• removing all or part of an affected organ, such as the prostate, a kidney, or a testicle
• removing the whole bladder (a cystectomy), which may be needed if a bladder cancer has grown into the muscle wall.

Non-surgical treatments may be used instead of, or alongside, surgery, including:

• radiotherapy, which uses high-energy rays to destroy cancer cells
• chemotherapy, which uses medicine to kill cancer cells, sometimes given directly into the bladder for early bladder cancers to help reduce the chance of the cancer returning
• hormone treatment, used for some prostate cancers to reduce the level of hormones that can help the cancer grow
• high-intensity focused ultrasound (HIFU), a newer option for some prostate cancers that uses focused sound waves to destroy cancer cells.

For testicular cancer, removal of the affected testicle followed by radiotherapy and/or chemotherapy usually provides a cure, even in cases where the cancer has spread.

When should I see a doctor?

See your GP as soon as possible if you notice:

• blood in your urine, at any age, even if it happens only once
• a lump, swelling, or any change in the size, shape or texture of a testicle
• a lump, sore or colour change on the skin of the penis
• a change in your usual pattern of passing urine that doesn't go away
• bone or back pain, unexplained weight loss, or loss of appetite.

In the UK, GPs can refer people with these kinds of symptoms through an urgent pathway, meaning you should be seen by a specialist within 2 weeks. Don't wait to see if symptoms go away on their own before getting checked.