Surgical Urological Oncology
Prostate cancer
Prostate cancer is the second most common cancer in men in the Western world. In the modern world, prostate cancer is diagnosed in the context of preventive screening and less often when it becomes symptomatic. Prostate cancer prevention includes after age 50 a digital exam and yearly PSA. In men with a history of prostate cancer, screening is recommended starting at age 45. When indicated in the preventive examinations, a prostate biopsy is recommended to confirm and stage the tumor. Recently, multiparametric magnetic resonance imaging is beginning to gain ground in diagnosis. Upon diagnosis, the abdomen is checked with a CT scan and the bones with a bone scan. The scintigraphy is performed because prostate cancer primarily resides in the bones. For non-metastatic disease, radical prostatectomy is recommended, which is simultaneously performed laparoscopically and robotically. Alternatively, there is also the possibility of radiation therapy if indicated. Hormonal therapy is performed for metastatic disease.
References:
http://uroweb.org/guideline/prostate-cancer/
http://www.imop.gr/pathhseis-prostath-adena/karkinos-prostath
Bladder cancer
Urothelial cancer is a common tumor and is found nowadays increasingly in both men and women. It is a curable tumor, but requires regular monitoring and treatment as indicated. A proven predisposing factor is smoking. The main symptom of urothelial cancer is painless gross hematuria. The diagnostic test includes ultrasound of the urinary tract, urine cytology, cystoscopy and CT urography if there are no findings in the previous ones.
The first step in treatment is transurethral removal of the tumor to assess the depth of the tumor. If the tumor is superficial, a regular re-check every three months with cystoscopy and urine cytology is recommended depending on the type of tumor and occasionally intravesical injections are recommended.
If the tumor infiltrates the muscular wall of the cyst, the chest and abdomen are checked for possible metastases. If there are no findings in the above control, neoadjuvant chemotherapy and subsequent radical cystectomy may be administered. On metastatic findings, the tumor becomes inoperable and the patient needs chemotherapy.
References:
http://www.imop.gr/ourologikoi-karkinoi/karkinos-kysths
https://www.huanet.gr/wp-content/uploads/2018/04/01.pdf
https://www.huanet.gr/wp-content/uploads/2018/04/07.pdf
http://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/
http://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/
Ureteral cancer
Cancer of the ureter occurs in ages >66 years and is a urothelial cancer. The symptoms and diagnostic course are similar to bladder cancer and ureteroscopic biopsy or removal of the tumor is added. Depending on the form and aggressiveness of the tumor, minimally invasive removal and regular ureteroscopic control are recommended in mildly aggressive forms of tumors, while in multiple or aggressive tumors, removal of the ureter and overlying kidney is recommended.
Cancer of the renal pelvis is a urothelial cancer and its diagnosis is as mentioned above. The treatment in the absence of metastases is the radical removal of the kidney and ureter.
References:
http://uroweb.org/guideline/prostate-cancer/
http://www.imop.gr/pathhseis-prostath-adena/karkinos-prostath
Kidney cancer
Kidney cancer is the third most common tumor of the urinary system and usually does not show any symptoms and is usually found incidentally during a routine checkup. For the diagnosis, the test of choice is computed tomography with contrast and, in case of doubt, magnetic resonance imaging. Treatment consists of radical nephrectomy and, if indicated, partial nephrectomy. In modern Urology, the operation is performed laparoscopically and robotically.
References:
http://www.imop.gr/ourologikoi-karkinoi/karkinos-nefroy
http://uroweb.org/guideline/renal-cell-carcinoma/
Testicular cancer
Testicular cancer is rare and occurs mainly in young men aged 20-40. It is a cancer with an excellent prognosis and almost zero mortality. The main symptom is the inhomogeneous swelling and hardness of the testicle which is palpated by the patient. Examination of choice for the diagnosis is the scrotal ultrasound, while at the same time some blood markers are sent to diagnose the type of cancer and to compare them before and after surgery. Treatment is orchiectomy.
References:
http://www.imop.gr/ourologikoi-karkinoi/karkinos-orxewn
https://www.huanet.gr/wp-content/uploads/2018/04/03.pdf
http://uroweb.org/guideline/testicular-cancer/
Penile cancer
Penile cancer is a rare cancer and occurs at age >60 years. There has been an association with the human papilloma virus (warts) without it being an absolute causative factor. Unfortunately, patients are slow to come for diagnosis and treatment and the disease at diagnosis is advanced. If diagnosed early, then prognosis and survival are very good. Depending on the indications, the treatment can range from minimally invasive (local excision) to amputation (radical peectomy).
References:
http://uroweb.org/guideline/penile-cancer/
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