ONCO-UROLOGICAL DISEASES: EARLY DETECTION, DIAGNOSIS, AND TREATMENT
Dr. Dilmurod Samikhovich Yunusov, a urologist and uro-oncologist with over 25 years of experience, discusses the risk factors, early signs, and modern treatment methods for urological cancers. Onco-urological diseases represent a significant public health concern worldwide. According to data from the International Agency for Research on Cancer (IARC), more than 2.5 million new cases of prostate, bladder, and kidney cancer were recorded globally in 2022 alone. These figures highlight the importance of timely diagnosis and early cancer detection, when a wider range of treatment options may be available. In this article, Dr. Dilmurod Samikhovich Yunusov, a urologist and uro-oncologist, discusses the characteristics of onco-urological diseases, their risk factors, symptoms, diagnostic methods, and treatment approaches. 1. What Is Uro-Oncology? What is uro-oncology, and which diseases fall within this field? Oncology is the branch of medicine that studies tumors, their causes, and the methods used for their detection, treatment, and prevention. In simple terms, every living organism consists of cells that continuously divide, regenerate, grow, and adapt to their environment. An oncologist specializes in studying and managing diseases that arise when these normal cellular processes become disrupted. Cells may undergo structural or functional changes due to genetic or epigenetic factors. When only one or a few abnormal cells are present, these changes are generally undetectable. The immune system can recognize and eliminate many abnormal cells before they develop into clinically significant abnormalities. However, when abnormal cells accumulate and proliferate uncontrollably, they may form a tumor. Tumors are classified as benign or malignant. Malignant tumors are cancerous growths. Each type has distinct characteristics and requires an individualized diagnostic and treatment approach. Uro-oncology specifically focuses on tumors affecting the urinary system and male reproductive organs, including cancers of the kidneys, urinary bladder, prostate, and other organs of the genitourinary system. Which onco-urological diseases do you encounter most frequently in your clinical practice? According to global statistics, men are particularly affected by several types of urological cancer. Prostate cancer is among the most frequently diagnosed cancers in men worldwide. Bladder and kidney cancers are also significant oncological diseases affecting the genitourinary system. In our clinical practice, the distribution of these diseases largely reflects global epidemiological patterns. However, as mentioned earlier, the entire human body is composed of cells that undergo numerous cycles of division and renewal throughout life. Consequently, tumors can develop in virtually any organ or tissue. The European Association of Urology (EAU) provides clinical guidelines covering the prevention, diagnosis, treatment, and follow-up care of urological diseases, including urological cancers. These guidelines are regularly reviewed and updated to reflect the latest scientific evidence and advances in clinical practice. As specialists, we strive to remain informed about these developments and incorporate current evidence-based recommendations into patient care. Which age groups are most susceptible to developing onco-urological diseases? Imagine a typical working day. At the beginning of the day, you feel refreshed and well-rested, allowing you to perform your tasks accurately and efficiently. However, as the day progresses, fatigue may affect your performance and increase the likelihood of errors. A somewhat similar process occurs in the human body as it ages. Most cancers are diagnosed more frequently in older adults. Over time, cells undergo repeated cycles of division, and genetic alterations may accumulate, increasing the likelihood of malignant transformation. Tumors occurring in childhood are often associated with genetic factors, whereas cancers developing later in life may result from a combination of accumulated genetic changes, environmental exposures, and other risk factors, including exposure to carcinogens. Therefore, onco-urological diseases can occur in individuals of different age groups. It would be inappropriate to exclude any patient from further assessment solely on the basis of age. Nevertheless, epidemiological data allow us to identify populations at higher or lower risk. For example, in the case of prostate cancer, discussions about prostate-specific antigen (PSA) testing are commonly recommended from approximately 50 years of age for men without additional risk factors. For individuals with an increased risk of prostate cancer, including those with a significant family history, such discussions may begin earlier, around the ages of 40–45. The appropriate age for initiating PSA testing and the frequency of subsequent examinations should be determined individually, taking into account the patient’s risk factors, overall health, and current clinical guidelines. To better understand the relevant risk factors and appropriate preventive measures, I recommend consulting a specialist, as this is a complex topic that requires an individualized approach. Why is it important to detect onco-urological diseases at an early stage? Recently, we have often heard people say, “Cancer has become much more common. We did not see so many cases in the past.” However, as medical professionals, we recognize that improvements in scientific knowledge, medical technology, and diagnostic capabilities have enabled us to identify many oncological diseases at earlier stages. Advances in diagnostic techniques have also improved our understanding of cancer and contributed to the development of more effective treatment strategies. Today, several treatment options are available for many types of cancer, depending on the disease, its stage, and the patient’s individual characteristics. Early diagnosis is particularly important because detecting cancer before it has progressed may provide more treatment options and improve the likelihood of a favorable outcome. Conversely, when cancer is diagnosed at an advanced stage, the range of available treatment options may become more limited, making disease management more challenging. 2. Main Causes and Risk Factors What factors increase the risk of developing kidney, bladder, and prostate tumors? Risk factors can generally be divided into two categories: modifiable and non-modifiable. Modifiable risk factors include lifestyle-related factors such as diet, physical activity, and harmful habits. Non-modifiable risk factors are those beyond our control, such as age, genetic predisposition, and certain inherited characteristics. Smoking is one of the most significant preventable risk factors for cancer, including several types of urological cancer. Other modifiable risk factors include obesity, occupational or environmental exposure to harmful substances, such as certain industrial chemicals and cadmium, and excessive alcohol consumption. Non-modifiable or underlying risk factors include hereditary predisposition and certain pre-existing medical conditions. Chronic kidney disease may also be associated with an increased risk of kidney cancer. It is important to understand that the significance of individual risk factors varies depending on the specific type of cancer. 3. Symptoms That Require Medical Attention What are the early symptoms that may indicate the presence of an onco-urological disease? One of the main challenges in uro-oncology is that symptoms may not appear until the disease has reached a relatively advanced stage. Many onco-urological diseases develop without noticeable symptoms, particularly in their early stages. For this reason, patients frequently consult us after an abnormality has been discovered incidentally during an examination for another medical condition or during a preventive health assessment. Nevertheless, one of the most important warning signs in urological practice is hematuria, which refers to the presence of blood in the urine. Hematuria can be classified into two types: • Gross hematuria: visible blood in the urine, which may cause the urine to appear pink, red, or brown. • Microscopic hematuria: blood that is not visible to the naked eye but is detected during laboratory urine testing. In patients with prostate conditions, lower urinary tract symptoms may also occur. These include changes in urinary flow, urgency (a sudden and difficult-to-control need to urinate), a sensation of incomplete bladder emptying, and nocturia (the need to wake up repeatedly at night to urinate). It is important to emphasize that these symptoms are not specific to cancer. They may also occur in a range of benign urological conditions. However, patients experiencing such symptoms should undergo an appropriate medical evaluation to identify the underlying cause and, where clinically indicated, rule out malignancy. If you notice any of these symptoms, do not delay seeking medical advice from a qualified specialist. What diseases may be associated with the presence of blood in the urine? Blood in the urine may be associated with tumors affecting the urethra, urinary bladder, ureters, or kidneys. An experienced urologist may use the appearance of the urine and the characteristics of the bleeding as part of the initial clinical assessment. However, these findings alone cannot reliably establish the source of bleeding. Hematuria can also have non-oncological causes, including urinary tract infections, urinary stones, injuries affecting the urinary tract, and side effects of certain medications. Therefore, the presence of blood in the urine requires appropriate medical evaluation to determine its cause. 4. Diagnosis of Onco-Urological Diseases What is the first step in evaluating a patient with suspected urological cancer? The diagnostic approach depends on the type of cancer suspected. In patients with suspected prostate cancer, the initial assessment may include measurement of prostate-specific antigen (PSA) levels, a digital rectal examination (DRE), and multiparametric magnetic resonance imaging (MRI) of the prostate. When bladder cancer is suspected, cystoscopy is performed to examine the inside of the urinary bladder using a specialized optical instrument. If a suspicious lesion is identified, tissue may be obtained for histopathological examination, typically through transurethral resection or biopsy. In cases of suspected kidney cancer, contrast-enhanced computed tomography (CT) is commonly used to evaluate the kidneys and surrounding structures. A multiphasic CT examination may include several imaging phases following intravenous contrast administration: • Arterial phase: approximately 20–30 seconds after contrast administration. • Nephrographic phase: approximately 80–120 seconds after contrast administration. • Excretory or delayed phase: approximately 5–15 minutes after contrast administration. The exact imaging protocol and timing are selected according to the clinical indication and the diagnostic objectives. In which cases is a biopsy necessary? When a suspicious lesion is identified in the urinary bladder or prostate, a biopsy or tissue sampling is generally required to establish an accurate diagnosis and determine the nature of the lesion. As mentioned earlier, tumors may be either benign or malignant. Histopathological examination allows specialists to identify the characteristics of the tissue and establish the diagnosis. The results play a crucial role in determining the subsequent treatment strategy and assessing the patient’s prognosis. 5. Treatment of Onco-Urological Diseases What treatment methods are used for tumors of the kidneys, urinary bladder, and prostate? Treatment depends on the location and type of the tumor, the stage of the disease, and the patient’s overall health. For kidney tumors, surgical treatment may involve either radical nephrectomy, which is the removal of the entire affected kidney, or partial nephrectomy, which involves removing the tumor while preserving the healthy portion of the kidney. The removed tissue is then sent for histopathological examination. Based on the results, the stage of the disease, and other clinical factors, the medical team determines whether additional treatment or surveillance is necessary. For bladder cancer, the treatment strategy largely depends on whether the tumor has invaded the muscular layer of the bladder wall. In cases of non-muscle-invasive bladder cancer, transurethral resection of the bladder tumor (TURBT) is commonly performed. Depending on the tumor’s characteristics and risk category, additional intravesical treatment and regular follow-up may be recommended. For muscle-invasive bladder cancer, treatment may involve neoadjuvant chemotherapy followed by radical cystectomy, which is the surgical removal of the urinary bladder, in appropriately selected patients. Other treatment approaches may also be considered depending on the patient’s condition and the characteristics of the disease. For localized prostate cancer, treatment options include active monitoring, radical prostatectomy, and radiotherapy. The ProtecT trial demonstrated that, for selected patients with clinically localized prostate cancer, prostate cancer-specific mortality remained low following active monitoring, surgery, or radiotherapy during long-term follow-up. However, these approaches differ in their effects on disease progression, adverse effects, and quality of life. Therefore, treatment should be selected individually following a comprehensive assessment and discussion between the patient and the treating specialist. When is surgical intervention necessary, and which minimally invasive surgical techniques are used in uro-oncology? Minimally invasive techniques are widely used in uro-oncology for both diagnostic procedures and surgical treatment. As mentioned earlier, obtaining tissue samples is an important part of diagnosing suspected prostate and bladder cancer. A prostate biopsy is commonly performed using a specialized needle under ultrasound guidance. MRI findings may also be used to guide the sampling procedure. This technique allows tissue samples to be obtained without making a conventional surgical incision. Bladder biopsies and transurethral resections are performed using endoscopic instruments introduced through the urethra, also without external surgical incisions. When surgical treatment is indicated, minimally invasive approaches, including laparoscopic and robot-assisted surgery, may be used for selected urological cancers. Compared with conventional open surgery, these techniques may reduce the size of surgical incisions, postoperative pain, and the duration of recovery in appropriately selected patients. Enhanced Recovery After Surgery (ERAS) protocols are designed to support early mobilization and recovery following surgical procedures. Depending on the type of surgery and the patient’s postoperative condition, mobilization may begin within the first few hours after the operation, sometimes as early as six hours after surgery. However, the timing of mobilization and the overall recovery process must always be individualized. 6. Prevention and Early Detection What measures can help reduce the risk of developing certain onco-urological diseases? Lifestyle modification plays an important role in reducing the risk of several types of cancer. The main preventive measures include quitting smoking, limiting or avoiding alcohol consumption, engaging in regular physical activity, maintaining a healthy and balanced diet, and keeping body weight within a healthy range. Avoiding unnecessary exposure to harmful substances and following appropriate preventive healthcare recommendations are also important. Screening examinations should be performed according to individual risk factors and current clinical guidelines. Although these measures cannot completely eliminate the risk of developing cancer, they can contribute to reducing the risk of certain malignancies and improving overall health. Who is recommended to undergo preventive urological examinations, and under what circumstances? A preventive consultation with a urologist can be beneficial, particularly for individuals who have an increased risk of developing urological diseases. Regular urological monitoring is especially important for patients with a family history of onco-urological diseases, as well as those experiencing any of the previously mentioned warning signs or symptoms. The need for screening and the frequency of preventive examinations should be determined individually by a specialist. What recommendations do you give to patients with a hereditary predisposition to cancer? I recommend taking your health seriously, attending regular preventive medical examinations, and following the screening schedule recommended by your healthcare provider.Patients with a significant family history of cancer should discuss their individual risk factors with a specialist to determine whether additional examinations or genetic counseling may be appropriate. 7. Conclusion: Expert Opinion What advice would you give to patients who notice concerning symptoms but postpone visiting a urologist because they are afraid of a possible diagnosis? Fear will not prolong your life, but courage might. Do not allow fear of a possible diagnosis to prevent you from seeking timely medical attention. Remember that your doctor is on your side. Our responsibility is to support you, establish an accurate diagnosis, and identify the most appropriate treatment strategy for your individual situation. If you have noticed concerning symptoms or are already aware of a suspicious mass or lesion, do not miss the opportunity to receive medical care at the appropriate time. Early detection can provide more treatment options and improve the chances of a favorable outcome.
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