Urological oncology

The most common tumor in the urological field is prostate carcinoma, or prostate cancer, which mainly occurs in older men. This is followed by renal cell carcinoma, bladder cancer, and testicular tumor - the latter is more common in young men.

Prostate cancer

Prostate cancer is a malignant disease of the prostate, a small gland below the man's bladder, responsible for producing part of the seminal fluid. It is one of the most common types of cancer in men, especially in older age. The prognosis is often good if prostate cancer is detected early; many men live for many years or even decades despite the diagnosis. Regular screening from age 45 - earlier if there is a family history - is therefore particularly important.

Causes and symptoms

Prostate cancer usually causes no symptoms in its early stages, which is why it is often detected late. The exact causes are not yet fully understood, but genetic factors, older age, family history, and hormonal influences (especially testosterone) are considered risk factors. An unhealthy diet, alcohol and nicotine consumption, overweight, and lack of exercise can also increase the risk. When symptoms occur, they present as frequent or difficult urination, a weak urine stream, pelvic pain, and blood in the urine or semen.

Diagnosis and treatment

Various methods are available for diagnosing prostate cancer. The most important method is the so-called PSA test (prostate-specific antigen), which determines a blood value that is often elevated in prostate cancer. Additionally, a digital rectal examination and often a transrectal ultrasound examination are used. If a tumor is suspected, a tissue sample is taken from the prostate and examined histologically. In advanced stages, imaging techniques are also necessary. The treatment of prostate cancer depends on the stage and aggressiveness of the tumor, the patient's age, and overall health. In the early stages, active surveillance may be sufficient, especially if the tumor grows slowly and causes no symptoms. In more advanced cases, surgical removal of the prostate, radiation therapy, or hormone therapy is used. In some cases, chemotherapy is also required, particularly for metastatic or hormone-resistant prostate cancer.

Renal cell carcinoma

Renal cell carcinoma is the most common form of kidney cancer in adults. It arises from the cells of the renal tubules, which are part of the kidney's filtration system. This type of cancer accounts for about 85% of all malignant kidney tumors. Renal cell carcinoma often develops slowly and remains undetected in its early stages, as it initially causes hardly any discomfort.

Causes and Symptoms

The exact causes of the development of renal cell carcinoma are not yet fully understood, but there are a number of risk factors. These include smoking, obesity, high blood pressure, certain genetic diseases, and long-term dialysis treatment. A family history can also increase the risk. The symptoms usually only appear in advanced stages of the disease. Typical signs include blood in the urine, pain in the flank or lower back, as well as palpable tumors in the abdomen. Other non-specific symptoms can include unexplained weight loss, fatigue, night sweats, or fever.

Diagnosis and Treatment

Diagnosis usually begins with a physical exam and medical history. If renal cell carcinoma is suspected, imaging procedures such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) are used to locate the tumor and assess its extent. A biopsy is only required in certain cases as imaging procedures are usually informative enough. The choice of treatment depends on the stage and spread of the tumor. In early stages, the surgical removal of the tumor is the treatment of choice—either in the form of partial removal of the kidney (partial nephrectomy) or complete removal of the affected kidney (nephrectomy). In advanced or metastatic tumors, targeted therapies or immunotherapies are used. Chemotherapy and radiation are generally less effective for renal cell carcinoma and are therefore rarely used.

The prognosis strongly depends on the stage of the disease at the time of diagnosis. If the carcinoma is detected and treated early, there are good chances of cure. In advanced stages, the therapy is mainly aimed at slowing the progression of the disease and maintaining quality of life for as long as possible.

Bladder cancer

A urothelial carcinoma is a form of cancer that develops in the lining (urothelium) of the urinary tract. The urothelium covers the inner surfaces of the renal pelvis, ureters, bladder, and urethra—however, the carcinoma most commonly occurs in the bladder, which is why it is often referred to as bladder cancer. The prognosis is largely dependent on the stage at diagnosis: early-detected, non-muscle-invasive carcinomas generally have good chances of cure, while advanced tumors often require complex and prolonged treatment. Regular follow-up examinations are crucial, as recurrences are common.

Causes and Symptoms

The causes of urothelial carcinoma are varied, with the most important risk factor being smoking—about half of all cases can be attributed to it. Other risk factors include occupational exposure to certain chemicals (e.g., in the chemical or dye industry), chronic bladder inflammation, radiation, or certain medications. Symptoms of bladder cancer can be inconspicuous for a long time. The most common symptom is bloody urine, which is painless and often occurs suddenly. Other possible symptoms include frequent urination, pain during urination, or lower abdominal pain—especially in advanced disease.

Diagnosis and Treatment

Diagnosis is usually made through a combination of medical history, physical examination, urine tests (e.g., to detect tumor cells), imaging such as ultrasound, CT, or MRI, and especially through bladder endoscopy (cystoscopy). If a tumor is suspected, a tissue sample (biopsy) is usually taken and examined histologically (microscopically). Treatment depends on the stage and location of the tumor. For superficial bladder tumors, a so-called transurethral resection (TUR-B) is usually performed, where the tumor is removed through the urethra. Additionally, therapy with chemotherapeutic drugs may be administered to prevent recurrence. In cases of muscle-invasive tumors, removal of the bladder (radical cystectomy) is often necessary, sometimes with urinary diversion. Additionally or alternatively, systemic chemotherapy or immunotherapy may be considered in selected cases.

Squamous cell carcinoma

Squamous cell carcinoma of the bladder is a rare but aggressive form of bladder cancer that arises from squamous epithelial cells—a type of cell that does not normally occur in the bladder but can develop with chronic irritation or inflammation.

Causes and Symptoms

Causes, such as chronic irritations, occur for example, due to long-term catheterization, urinary stones or chronic infections, and are considered one of the main causes. Typical symptoms are similar to those of other bladder tumors and primarily include blood in the urine and painful or difficult urination (dysuria), frequent urge to urinate, and occasional flank pain. Because these symptoms are nonspecific and can also occur in less serious diseases, diagnosis is often delayed.

Diagnosis and Treatment

Here too, diagnosis begins with a urine test and imaging procedures like ultrasound or CT. The decisive method for diagnosis is, however, cystoscopy with tissue sampling (biopsy), as only histological examination provides information about the cell type and tumor stage. Therapy depends on the stage of the tumor. In most cases, surgical removal of the bladder (radical cystectomy) is necessary, as squamous cell carcinoma is often detected at an advanced stage and responds less well to chemotherapy than transitional cell carcinoma. Chemotherapy can be used in addition to surgery or palliatively. The prognosis is generally poorer than for other forms of bladder cancer, mainly due to the late diagnosis and the biological aggressiveness of the tumor.

Testicular cancer

Testicular tumors are benign or malignant growths of the testicular tissue, which primarily occur in young men between the ages of 20 and 40. These are mostly germ cell tumors that develop from the cells which later give rise to sperm. These tumors are further classified into seminomas and non-seminomas, with seminomas usually growing more slowly and metastasizing later than non-seminomas.

Causes and Symptoms

The exact causes of testicular cancer are not completely understood, but there are several risk factors. These include a cryptorchidism (undescended testis), genetic predisposition, or familial clustering. Environmental factors and hormonal influences are also suspected to play a role. Typical symptoms include a painless hardening or swelling of the testis, a pulling sensation in the testis or groin, and a feeling of heaviness in the scrotum. Very rarely do pain, breast enlargement (gynecomastia), or symptoms due to metastases—such as back pain or shortness of breath—occur.

Diagnosis and Treatment

Initially, the urologist conducts a physical examination, followed by an ultrasound examination of the testes. Blood tests are also performed to determine what are known as tumor markers. Further investigation usually involves surgery, in which the affected testis is removed and examined histologically. Imaging procedures such as CT or MRI are then used to assess the spread and metastases. Treatment depends on the type of tumor and the stage of the disease; usually, however, the affected testis is surgically removed. Depending on the type and spread of the tumor, chemotherapy or sometimes radiation therapy (especially for seminomas) follows. In advanced stages, further surgery may be necessary to remove lymph nodes. Thanks to modern therapies, the chances of recovery with early diagnosis are very good - in localized tumors, they are over 95%. Regular follow-up examinations are essential to detect any recurrence early on.

Penile cancer

Penile cancer is a malignant tumor disease of the penis, usually originating from the skin or mucous membrane. In most cases, it is what is known as squamous cell carcinoma that develops from the upper cell layers of the glans, foreskin, or shaft of the penis. This form of cancer is generally rare but occurs more frequently in older men, particularly from the age of 60 onwards. If detected and treated early, there are good chances of recovery. Regular medical checkups, particularly for patients at risk, and preventive measures such as good intimate hygiene and HPV vaccination in adolescence are therefore essential.

Causes and Symptoms

The causes of penile cancer are varied. The main risk factors include chronic inflammation or irritation of the penile skin, often due to inadequate hygiene or phimosis. An infection with the human papillomavirus (HPV) can also play a significant role in cancer development. Other risk factors include smoking, immunosuppression, or a previous cancerous condition in the genital area. In its early stages, penile cancer often progresses without noticeable symptoms. The first signs can include skin changes such as hardening, lumps, redness, or small, non-healing ulcers on the penis. Weeping or bleeding areas as well as discharge under the foreskin are also possible. In later stages, there may be pain, swelling of the lymph nodes in the groin, or even difficulties urinating.

Diagnosis and Treatment

Diagnosis is usually made by a physical examination in which suspicious skin lesions are assessed. A biopsy additionally secures the diagnosis. Imaging procedures such as ultrasound, MRI, or CT can also be used to detect the spread of the tumor and possible lymph node metastases. The treatment depends on the stage of the tumor. In the early stages, a local operation to remove the tumor may be sufficient, sometimes preserving the penis. In advanced cases, partial or complete amputation may be necessary. Radiation therapy or chemotherapy may also be considered as an adjunct or alternative, especially if the tumor is advanced or metastases are present. In some cases, immunotherapy is also considered for HPV-related tumors.