With ‘Movember’ awareness month shining the spotlight on men’s health, a urologist from global health system Cleveland Clinic is advising men on important checks and symptoms for three common urological cancers.
“We encourage patients to undergo appropriate kidney, prostate and bladder screenings as the earlier these cancers are diagnosed, the more treatable they are. In general, treatments at an earlier stage are less invasive and the outcomes better. We also advise individuals never to ignore any urological symptoms, but instead to discuss these with a physician, and be sure to mention any family history of cancers,” says Jihad Kaouk, M.D., a urologist and Director of Robotic Surgery at Cleveland Clinic’s Glickman Urological & Kidney Institute.
- Kidney cancer screening
“Kidney cancers tend to occur later in life, most commonly from age 60 onwards, although younger people can still develop kidney cancer. Typically, we will screen younger men when they have symptoms, which could include anything abnormal such as blood in the urine, flank pain and fever. However, kidney cancers are usually a silent disease, so from the age of 60 and above, kidney screens should be a routine part of a man’s annual check-up,” Dr. Kaouk says.
A simple abdominal ultrasound can be useful in kidney screening, particularly in people with a family history of kidney disease or who present with symptoms, says Dr. Kaouk. If an abnormality is picked up, for example a mass on the kidney, then a contrast-enhanced MRI or CT scan will confirm a diagnosis and determine the next steps. Dr. Kaouk adds that since kidney cancer usually develops without symptoms, masses are often found incidentally, when a patient is screened for another reason.
“Treatment options for localized kidney masses are usually straightforward with a very high rate of cure if the disease is caught early,” Dr. Kaouk says.
- Prostate cancer test
Dr. Kaouk points out that prostate cancer is common to the extent that if all men lived to the age of 90 and beyond, all men would have developed it. “Given this high prevalence, we focus on treating men with aggressive prostate cancer as well as those who develop it at an earlier age,” he says. “For older patients or less aggressive forms of prostate cancer, active surveillance is the preferred approach, with treatment initiated only if necessary.”
“Annual testing for prostate cancer is important for men aged 50 and above. However, if individuals have a first-degree relative who was diagnosed with prostate cancer, they should start screening as early as age 40. In addition to a physical examination, screening is done through a blood test to detect raised levels of a protein called prostate-specific antigen, or PSA. This protein is produced by both cancerous and noncancerous tissue in the prostate, so having a high number doesn’t necessarily mean a person has cancer as there could be many other causes,” Dr. Kaouk says.
If a nodule or bulge is felt during the rectal physical examination, Dr. Kaouk says a biopsy will be taken regardless of the PSA results. “The good news is that the method of taking the biopsy has vastly improved over the years, greatly reducing any risk of infection or bleeding. At Cleveland Clinic, we usually now use a special type of MRI, called multiparametric MRI, which is fused with an ultrasound image, enabling very precise prostate biopsy.”
If the biopsy indicates cancer, Dr. Kaouk says a treatment plan will be formulated based on the classification of how aggressive it is, and taking into account existing comorbidities and life expectancy.
“Bladder cancer can be life-threatening, and it is time sensitive as it can be very aggressive, spreading quickly. Smokers are at particularly high risk for bladder cancer so they need to be extra vigilant. There is no routine bladder cancer test, but patients will be screened if they report symptoms. The most common symptom is blood in the urine. Fortunately, screening is very simple, and conducted through inserting a scope into the bladder to examine it, in addition to urine tests.”
Dr. Kaouk says that if polyps are found in the bladder, they can usually be scraped out. However, if the cancer has advanced significantly, the bladder may have to be removed, which is life-changing.
“Movember is a great opportunity to create awareness of these common cancers found in men, and to encourage them to speak openly to their doctors about any symptoms they experience. Doing so could greatly improve their outcomes or even save their lives,” Dr. Kaouk concludes.