Bladder Cancer
Definition

• Malignancy arising from the bladder urothelium


• Most common type is urothelial carcinoma


• Often presents with painless hematuria

Risk Factors

• Cigarette smoking


• Occupational chemical exposures such as dyes and rubber


• Chronic bladder irritation or infection


• Cyclophosphamide therapy (chemotherapy agent)

Clinical Presentation

• Painless gross hematuria is classic


• Irritative voiding symptoms such as frequency or urgency


• Flank pain if obstruction occurs


• The question stem would likely describe an older smoker with painless blood in the urine

Diagnostics

• Urinalysis: hematuria


• Urine cytology: may detect malignant cells


• Cystoscopy with biopsy: diagnostic test of choice


• CT urography or renal ultrasound: evaluate upper tracts for masses or obstruction

Treatment

• Transurethral resection of bladder tumor for diagnosis and initial management


• Urology referral for cystoscopy


• Advanced disease may require more extensive surgery or systemic therapy


• Ongoing surveillance cystoscopy due to high recurrence

Exam Keys

• Painless hematuria in older patient = bladder cancer


• Smoking is strongest risk factor


• Cystoscopy with biopsy is required for diagnosis


• High recurrence rate requires surveillance

Penile Cancer
Definition

• Malignancy of the penis, usually squamous cell carcinoma


• Rare in the United States

Risk Factors

• HPV infection


• Lack of circumcision with chronic smegma accumulation


• Phimosis


• Smoking


• Poor hygiene

Clinical Presentation

• Painless penile mass, ulcer, or lesion


• May bleed or become foul smelling


• Inguinal lymphadenopathy in advanced cases


• The question stem would likely describe an uncircumcised man with a persistent penile lesion or ulcer

Diagnostics

• Clinical exam and biopsy of the lesion


• HPV testing may be supportive but not required


• Imaging (CT or MRI) if concerned for nodal or metastatic spread

Treatment

• Surgical excision is mainstay


• Topical or laser therapy for very superficial lesions


• Partial or total penectomy for invasive disease


• Radiation or chemotherapy for advanced or metastatic cases

Exam Keys

• Uncircumcised male with chronic lesion = think penile cancer


• Strongly associated with HPV and poor hygiene


• Diagnosis requires biopsy


• Treatment is surgical excision

Prostate Cancer
Definition

• Malignancy of prostate gland, usually adenocarcinoma


• Most common non-skin cancer in men


• Often slow growing and asymptomatic early

Risk Factors

• Age over 50


• African American race


• Family history


• BRCA mutations

Clinical Presentation

• Often asymptomatic


• May have urinary hesitancy, weak stream, or nocturia


• Bone pain suggests metastasis


• The question stem would likely describe an older man with urinary obstructive symptoms or elevated PSA

Diagnostics