Urinary system cancers are principally prostate cancer, kidney cancer and bladder cancer.

PROSTATE CANCER

Overview

Prostate cancer is the commonest cancer in men. Its progress is generally slow, and symptoms sometimes remain hidden for several decades.

The risk of prostate cancer increases with age and with a family history. Dietary factors, such as a diet too rich in meat or fat, may also play a part. In Belgium, about 9,000 new cases occur each year.

The most suitable treatment for each patient therefore needs to be defined after considerable thought, involving specialists from many different fields. It is not always easy to predict how this cancer will develop.

Symptoms and screening

Prostate cancer does not generally produce any symptoms, except when advanced or if there are urinary manifestations (difficulty in urinating, frequent desire to urinate). Bone problems (pains in the bones or fractures) may occur.
As there are no symptoms in the early stages, early diagnosis of the disease requires screening.

Screening involves palpating the organ during a rectal examination, and measuring PSA (prostate specific antigen) concentrations in the blood. PSA is specific to the prostate but not to cancer. In other words, increased concentrations of this antigen can be caused by other prostate problems, such as infection.
For this reason, use of PSA is currently being called into serious question. Thankfully, new tests are being studied, such as searches for cancer cells in urine (PCA3 test), available at Cliniques Universitaires Saint Luc (Figure 1).

Figure 1. The Progensa PCA3 test searches for cancer cells in a patient’s urine following a rectal examination. This test increases the sensitivity and specificity of diagnosis through rectal examination and PSA.

 

Treatment

 

If cancer is discovered during screening, initial treatment will not always be necessary. Some cases of the disease is not aggressive and will be of little or no consequence. In other cases, there is a greater likelihood of rapid development and treatment will be necessary immediately upon diagnosis.

 

The best approach therefore needs to be defined according to the characteristics of the cancer discovered, and to ensure that treatment best preserves the patient’s quality of life.

 

In localised cancers, without major extension, treatment mainly involves surgical removal of the prostate (prostatectomy) or radiotherapy. Tomotherapy, a technique used in our centre, now directs rays at tumours using a scanner, making treatment more effective by preventing damage to neighbouring healthy tissue (Figure 2).

At a more advanced stage, anti-hormonal treatment is usually used. New drugs are being used as part of studies being conducted by our centre in association with other European and American centres. Investigations are concentrating on the importance of treatment combining hormone therapy and chemotherapy.

Figure 2 :Tomotherapy

Preserving quality of life is top priority.

Preserving quality of life remains a major concern, whatever the treatment accepted, and it therefore needs to be reliably assessed. Removal of the prostate, the procedure in treatment of localised cancers, can lead to sexual problems and urinary incontinence. The multidisciplinary team dedicated to treatment of prostate cancer, has produced tools that help assess the risk of such complications, and, should they occur, define and reduce their impact on a patient’s well-being.

Effective hormone therapy, the main treatment given in advanced cases, carries a risk of side effects such as hot flushes or reduced sexual performance. Specialists in the multidisciplinary group have set up a national communication campaign aimed at informing doctors and some 22,000 patients on the effects of hormone therapy.

Finally, advanced cases of the disease often present bone metastases. It is important to diagnose these rapidly and to assess new treatments currently becoming available. The multidisciplinary team for urinary cancers has, with help from the Fondation Saint-Luc, developed a magnetic resonance imaging (MRI) tool that reveals bone metastases at a very early stage and monitors their size during treatment. Its technology produces three-dimensional images of bone marrow (Figure 3), and is now being used in numerous other reference centres in Europe.

KIDNEY, BLADDER AND TESTICULAR CANCER

Kidney cancer, an uncommon tumour, presents few symptoms and is often discovered by chance during an X-ray examination. It can be triggered by a genetic predisposition.

Surgery has long since been the only form of treatment and remains the procedure of choice if the cancer has not spread. It involves removal of the kidney (nephrectomy), which is usually partial, as the cancers discovered today are small. Partial nephrectomy is less drastic than total or radical nephrectomy, and as such is better tolerated.

The arrival of targeted therapies, drugs capable of targeting the finely balanced mechanisms behind kidney cancer, is a major step forward in treatment of advanced cases of the disease. These treatments are available at our centre.

Bladder cancer is often revealed through visible presence of blood in urine. This symptom, which can also be indicative of other conditions, requires an immediate consultation. The principal factor behind bladder cancer is smoking.

This cancer, slightly commoner than kidney cancer, is treated locally either by removal of superficial lesions or by removal of the bladder (cystectomy). If metastases are involved, treatment will involve chemotherapy.

Testicular cancer is the commonest cancer in young adults. The condition can often be cured, but a multidisciplinary care approach is required.
 

Figure 3 : Magnetic resonance imaging of the entire body should allow extended examinations for genitourinary cancers to be carried out in a single session.