9/13/2017. Highgate Private Hospital & Whittington Health NHS Trust. London Cancer Urology Guidelines for Target Referrals. Urological Cancer Groups

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1 London Cancer Urology Guidelines for Target Referrals Mr Paul Erotocritou MBBS BSc MSc, MRCS, FRCS (Urol)Eng Highgate Private Hospital & Whittington Health NHS Trust Urological Cancer Groups 5 groups: Prostate Bladder Penis Testicle Renal Prostate Cancer Risk Factors Increasing Age average age of diagnosis years Family history 1 st degree male relative diagnosed with prostate cancer 2.5 times increased risk 1 st degree female relative with breast cancer, BRCA1/2 carriers Ethnicity 1

2 Prostate Cancer Prostate Cancer Prostate Specific Antigen (PSA) Test Consider a prostate specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in patients with: Any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention Erectile dysfunction Visible haematuria 2

3 PSA Test For patients with an increasing PSA level that remains below the British Association of Urological Surgeons (BAUS) age-specific threshold there is no evidence that a suspected cancer referral is required. Where the result is just below the age-specific threshold, you should consider repeating the PSA test after one month. PSA Test A referral using a suspected cancer pathway (for an appointment within 2 weeks) is recommended for all men with a PSA above the age-specific threshold even in the presence of a urinary infection. PSA Test For patients with an increasing PSA level that remains below the British Association of Urological Surgeons (BAUS) age-specific threshold there is no evidence that a suspected cancer referral is required. Where the result is just below the age-specific threshold, you should consider repeating the PSA test after one month. 3

4 BAUS PSA AGE-SPECIFIC THRESHOLDS Age (years) PSA Value (ng/ml) Prostate Cancer Referral Criteria Prostate feels malignant on digital rectal examination PSA levels are above the British Association of Urological Surgeons (BAUS) age-specific reference range 4

5 Bladder Cancer 10,000 people diagnosed per year 7 th most common cancer in the UK 1 in 39 lifetime risk of diagnosis in men 1 in 110 lifetime risk of diagnosis in women 60% diagnosed with superficial bladder cancer at presentation Smoking is the greatest risk factor for developing bladder cancer 5

6 Haematuria Visible haematuria/macroscopic Haematuria % rate of malignancy Nonvisible haematuria/dipstick haematuria -5-10% rate of malignancy Bladder Cancer: Referral Criteria Adults with visible haematuria that persists or recurs after successful treatment of urinary tract infection Adults with unexplained visible haematuria without urinary tract infection Adults with unexplained non-visible haematuria and dysuria or a raised white cell count on a blood test Areas of contention Persistent microscopic haematuria. Non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent UNEXPLAINED urinary tract infection. 6

7 Penile Cancer Penile cancer accounts for less than 1% of all new cases in the UK (2014). There were around 630 new cases of penile cancer in the UK in 2014, that s around 2 cases diagnosed every day. More than 4 in 10 (43%) penile cancer cases in the UK each year are diagnosed in males aged 70 and over ( ). Incidence rates for penile cancer in the UK are highest in males aged 90+ ( ). Most penis cancers occur in the glans penis. 1 in 585 men will be diagnosed with penile cancer during their lifetime. Risk Factors An estimated 40% of penile cancers in the UK are linked to HPV. Penile cancer risk is around 4 times as high in people with HIV/AIDS compared with the general population. Penile cancer risk is more than 4 times as high in current smokers Penile cancer risk among men who were not circumcised in childhood is at least 5 times as high in those with a history of phimosis (inability to retract the foreskin over the glans), compared with those without a history of phimosis Age Penile Cancer Referral Criteria Penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded Persistent penile lesion after treatment for a sexually transmitted infection has been completed Unexplained or persistent symptoms affecting the foreskin or glans 7

8 Testicular Cancer 1 in 195 men will be diagnosed with testicular cancer during their lifetime. Almost half (47%) of testicular cancer cases in the UK each year are diagnosed in males aged under 35 ( ). Testicular cancer is more common in White males than in Asian or Black males. Most testicular cancers occur in descended testicles. Risk Factors Testicular cancer risk is around 3-4 times higher in males with cryptorchidism Testicular cancer risk is around 4-5 times higher in men whose father was diagnosed with the disease Testicular cancer risk is 8-9 times higher in men with a brother diagnosed with the disease. Testicular Cancer Referral Criteria A solid intra-testicular lump Non-painful enlargement or change in shape or texture of the testis Abnormal testicular ultrasound suggestive of cancer 8

9 Thoughts Microlithiasis Intratesticular Cysts Imaging modality Renal Cancer Kidney cancer is the seventh most common cancer in the UK (2014) Half (50%) of kidney cancer cases in the UK each year are diagnosed in people aged 70 and over ( ). 1 in 52 men and 1 in 87 women will be diagnosed with kidney cancer during their lifetime 50% are diagnosed as an incidental finding Kidney cancer incidence rates have increased by 78% in the UK since the early 1990s. Risk Factors An estimated 24% of kidney cancers in the UK are linked to overweight and obesity Kidney cancer risk is 33% higher in current smokers compared with non-smokers Renal cell carcinoma risk is times higher in people with a first-degree relative with kidney cancer 9

10 Renal Cancer Referral Guidelines Abnormal ultrasound suggestive of renal cancer Adults with unexplained visible haematuria without urinary tract infection Adults with visible haematuria that persists or recurs after successful treatment of urinary tract infection Any Questions? Contact Details Highgate Private Hospital Clinics: Tuesday and Thursday EVE (weekly) T: E: Other queries: 10