New Treatments Offer Hope for Urologic Cancers

While April is National Testicular Cancer Awareness Month, it’s just one of several diseases that can affect one’s urologic system. Cancers can also develop in the prostate, bladder and kidneys, says David A. Taub, M.D., director of urologic oncology with Lynn Cancer Institute at Boca Raton Regional Hospital.

Testicular cancer: rare but extremely survivable.

According to the National Institutes of Health (NIH), only 9,470 new cases of testicular cancer will be diagnosed this year, less than half of one percent of all new cancer cases. It is most frequently diagnosed in men aged 20-34, the NIH says.

Dr. Taub says that the risk factors for testicular cancer include:

• Having cryptorchidism (an undescended testicle) or a testicle that is not normal in some way.

• Having testicular carcinoma in situ, meaning a group of abnormal cells that remain where they formed and do not spread.

• Being Caucasian.

• Having a personal or family history of testicular cancer.

• Having Klinefelter syndrome, a genetic disorder in males caused by having one or more extra X chromosomes.

“The good news is that most testicular cancers can be cured, even if they’re caught late,” says Dr. Taub. “With appropriate treatment, nearly 95 percent of men diagnosed with the disease will survive it and lead long, healthy lives.”

Treatment options for testicular cancer include surgery, radiation therapy and chemotherapy, he says. “Here at Lynn Cancer Institute, we provide personalized care and develop treatment plans that are best for the individual patient.”

Prostate cancer among most common cancers in men

Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States, according to the U.S. Centers for Disease Control & Prevention (CDC), and it is one of the leading causes of cancer death among men of all races and Hispanic origin populations.

One in eight American men will be diagnosed with prostate cancer in their lifetime, the CDC says, with an average age at diagnosis of 66.

Most at risk for developing prostate cancer are:

• Older men (“Age is the most common risk factor for prostate cancer,” says Dr. Taub.)
• African-American men (33 percent chance of developing prostate cancer in their lifetime)
• Those with a family history (especially if it includes a father or a brother with the disease).

Mortality rates for prostate cancer have declined since the 1990s, according to Dr. Taub. “While screenings that test for prostate-specific antigens (PSA) have aided in early detection and increased the number of men diagnosed with the disease, new and effective treatments are reducing mortality and helping many patients lead long and active lives,” he says.

Robotic prostatectomy has been the traditional surgical approach for treating prostate cancer, says Dr. Taub, but new surgical techniques such as High Intensity Focused Ultrasound (HiFU) are proving to be effective. “For patients with advanced disease, we’re also seeing improved outcomes with hormone therapy that uses anti-androgen drugs to arrest the production of testosterone, which can fuel the growth of cancer cells in the prostate.”   

Bladder cancer affects men, mostly, but women get it, too

Each year, according to the American Cancer Society, roughly 80,000 new patients are diagnosed with bladder cancer, and around 17,500 patients die from the disease. More than 75 percent of those diagnosed are men, and 90 percent are over age 55. The average age at diagnosis is 73.

The single biggest risk factor for bladder cancer is tobacco use but older men and Caucasians also have a higher risk of developing the disease, the CDC says. Other risk factors include:

• Having a family history of bladder or urothelial cancer.
• Having certain genetic mutations such as Lynch Syndrome, an inherited disorder in which affected individuals have a higher-than-normal chance of developing colorectal cancer and certain other types of cancer, often before the age of 50.
• Working with organic chemicals, such as those used in the textile, dye, paint, leather, printing, or rubber industries.
• Taking certain chemotherapy drugs, or diabetes medicines such as pioglitazone.
• Receiving chemotherapy or radiation treatment.
• Having chronic urinary tract infections.
• Drinking well water contaminated with arsenic.

According to Dr. Taub, bladder cancer can be hard to detect and tumors may be missed in up to 25 percent of cases. “We use blue light cystoscopy, a simple and painless outpatient procedure in which any tumors on the bladder light up bright pink on imaging,” Dr. Taub says. Because there is a high risk of relapse with bladder cancer, he says blue light cystoscopy is also an effective post-treatment monitoring tool.

Depending on how advanced the disease is, bladder cancer can be treated with surgery, intra-vesical therapy, chemotherapy and immunotherapy. “Monocolonal antibody-drug conjugates such as Enfortumab, which deliver chemotherapy directly to the cancer cell, are proving to be an effective treatment for bladder cancer,” Dr. Taub says. Some promising new therapies are on the horizon, too, he adds. “It’s not yet FDA-approved but Nadoferegene firodenovec is a novel drug that uses a viral mechanism to infect and kill cancer cells.”

Kidney cancer most often detected when testing for something else

Kidney cancer affects nearly 74,000 a year, according to the CDC, and close to 25 percent of those cases are fatal. There is no real screening for kidney cancer, Dr. Taub says. “A patient may complain of pain or a palpable mass, but kidney cancers are most often detected incidentally on imaging for other causes.”

Smoking, again, is the most important risk factor for kidney and renal pelvis cancers, Dr. Taub says. Other risk factors include:

• Having high blood pressure. (“It isn’t known whether the increased risk is due to high blood pressure itself or the medicines used to treat it,” Dr. Taub says.)
• Being overweight or obese.
• Taking certain pain medicines for a long time.
• Having certain genetic conditions.
• Having a long-lasting infection with Hepatitis C. 
• Having kidney stones.
• Having sickle cell trait, which is associated with renal medullary carcinoma, a rare form of kidney cancer.
• Being exposed to a chemical called trichloroethylene, used to remove grease from metal.

Surgical options for kidney cancer include percutaneous or laparoscopic thermal ablation and robotic partial or radical nephrectomy. “Both have equivalent oncologic outcomes, with improved renal function,” says Dr. Taub. Radiation therapy is also an option, he adds.

Targeted therapies, which attack proteins in cancer cells that help them to grow and survive, are now being used to treat recurrent or advanced kidney cancer, according to Dr. Taub. Similarly, he says, immunotherapies are available that zero in on the proteins cancer cells use to “cloak” themselves in order to evade the body’s immune system defenses.