Cancers of the male genital system

Male Gential System diagram

Prostate cancer

Facts and figures

Prostate cancer is the most common male cancer in the UK, accounting for 25% of all new male cancers.

Age related, the incidence rises sharply from 50 years of age with the highest incidence in those 75-79 years and higher incidence in men of Afro-Caribbean descent.

Risk factors include a first or second degree relative diagnosed with prostate cancer, mother having breast cancer, BRCA2 gene mutation, a diet high in calcium, prostatitis and having had a vasectomy. 95% of prostate cancers are adenocarcinomas and many will cause no problems.

Post mortems on male patients dying of unrelated causes have shown that 75% of these patients have some evidence of prostate cancer. An enlarged prostate, a condition known as benign prostatic hypertrophy (BPH) is common in older men but will not necessarily become malignant; however, some symptoms will be similar.

Symptoms may include:

  • In early stage disease, there may be no symptoms.
  • Sometimes detected following blood tests if prostate specific antigen (PSA) test requested, although this is not conclusive of prostate cancer as the PSA can be raised due to other factors such as urinary infections.
  • Urinary frequency, particularly at night.
  • Urgency to pass urine.
  • Difficulty and /or pain on passing urine.
  • Blood in the urine or semen (rare).

Diagnosis

Investigations may include:

  • Blood tests (will include prostate specific antigen – PSA).
  • Rectal examination.
  • Ultrasound scan.
  • Needle biopsy.
  • CT scan.
  • MRI scan.
  • Bone scan (not routine).

Treatment

Depends on several factors:

  • Symptoms and impact on quality of life.
  • Cancer cell type (Gleeson score).
  • Stage of the cancer.
  • Age and general health.

Monitoring (watchful waiting and active surveillance)

Most prostate cancers develop very slowly and in some cases do not cause any problems, therefore it may be inappropriate to actively treat these patients, consequently avoid long term side effects which can impact on the patient’s quality of life.

Watchful waiting may be undertaken for locally advanced or metastatic cases that are symptomless and involves keeping treatments in reserve to control the disease if required at a later date. These patients may have blood tests and examinations and possibly a bone scan but would not usually have prostate biopsies.

Active surveillance involves regular PSA blood tests, rectal examinations and prostate biopsies at 12 monthly intervals and would be used for localised tumours.

Surgery

If the tumour starts to develop on active surveillance or is thought to be intermediate/high risk localised disease, surgical removal of the prostate (prostatectomy) may be advised.

Localised disease is defined by the tumour being contained within the capsule covering the prostate gland. If possible surgeons will try to avoid damage to the nerve bundles around the prostate to preserve potency.

Radiotherapy

External radiotherapy may be advised for patients with high risk localised or locally advanced disease.

Locally advanced disease is defined as the tumour having broken through the capsule but has not spread to other parts of the body. In cases of localised disease, there is around a 66% cure rate with radiotherapy. It can be used as an alternative for patients not fit for surgery or who have declined surgery.

Post-operative radiotherapy might be recommended if there is thought to be a risk of recurrence at surgery.

Radiotherapy can have long term side-effects due to the proximity of the prostate in relation to bowel, bladder and nerves. However, the use of intensity modulated radiotherapy (IMRT) has proved to increase the effectiveness of treatment by enabling the disease to be targeted very accurately hence reducing dose to healthy tissue and reducing side effects.

Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues by allowing the radiography team to monitor organ position and ideally adapt the patient position on a daily basis to ensure precision.

Internal radiotherapy (brachytherapy) can be used in some cases of localised disease thought to be of low/intermediate risk. This may be the implantation of small radioactive seeds into the prostate, which slowly release a low dose of radiation over a few months or high dose brachytherapy (HDR) where radioactive wire is inserted into thin tubes that have been put into the prostate.

The HDR procedure takes about 2 hours and is likely to be followed by a course of external radiotherapy. Radiotherapy is often used if the disease has spread to other parts of the body, particularly bone secondaries for pain control.

Hormones

The purpose of hormone therapy is to either stop the production of testosterone (this occurs in the testicles) or block the effects of it as prostate cancer depends on this to be able to develop.

It may be prescribed in early prostate cancer to reduce the risk of recurrence after surgery or radiotherapy or in advanced cases to either shrink the tumour or slow the progression of it and relieve symptoms, sometimes hormones only are a suitable treatment.

In cases of locally advanced prostate cancer, particularly before radiotherapy (neo-adjuvant therapy), hormones may be given to reduce the size of the prostate and increase the effectiveness of treatment (this is usually for a minimum of 3 months).

In a very few cases now, patients will have the testicles removed (orchidectomy) which results in no further production of testosterone.

Chemotherapy

Chemotherapy is mainly used to treat disease that has spread to other parts of the body and is not responding to hormone therapy.

Penile cancer

Facts and figures

Penile cancer is very rare, only around 550 new cases are diagnosed each year in the UK, but this is increasing, thought possibly to be linked to increase in sexually transmitted disease.

It is rare in those under 40 years of age and most cases are in men over 60years. Over 95% of tumours are squamous cell carcinomas. Risk factors include exposure to HPV, multiple partners before the age of 20, poor hygiene and possibly smoking or a depressed immune system.

Symptoms may include:

  • Change in colour and /or thickening of skin.
  • Non-healing growth or sore on the penis.
  • Bleeding from the penis or foreskin.
  • Foul smelling discharge.
  • Difficulty in drawing back the foreskin (phimosis).

Diagnosis

Investigations may include:

  • Physical examination
  • Biopsy- tissue samples will be taken for analysis CT scan MRI scan Ultrasound scan reviewing lymph nodes in the groin Fine needle aspiration (FNA) may be performed if abnormal lymph nodes are suspected- a thin needle may be used to collect cells from the lymph nodes for analysis.

Treatment

Depends on several factors:

  • The type of tumour.
  • The size and position of the tumour.
  • The stage of the cancer.
  • Age and general health.

Very early stage carcinoma in situ may be treated with a chemotherapy cream (usually fluorouracil 5FU) or imiquimod which uses the immune system to treat the cancer.

Surgery

Surgery is the main treatment for penile cancer where the tumours are very small this may be laser surgery or cryosurgery.

In other cases it may conventional surgery such as circumcision if only the foreskin is involved or it may involve a wide local excision to remove the affected tissue with a clear margin and possibly lymph nodes.

Total or partial removal (penectomy) is only performed if the disease is deep into the penis or at the base, usually followed by reconstruction.

Radiotherapy

Radiotherapy may be used if the patient is not fit for surgery or declines surgery. Also, it will be treatment of choice if the disease has spread to the lymph nodes in the groin or into the pelvis.

Post-operative radiotherapy might be suggested to reduce risk or spread/recurrence.

Chemotherapy

Chemotherapy cream can be used for carcinoma in situ. Intravenous chemotherapy may be used if the disease has spread to other parts of the body.

Testicular cancer

Facts and figures

Testicular cancer is the 16th most common male cancer in the UK, around 2,200 new cases diagnosed in the UK each year, which is approximately 1% of all new male cancer cases.

Age related but unusually more common in young men. It can occur in children and young teenagers but an average of 84% are diagnosed in the 15-49 years age group and only 6% in those 60+ years. 95% are germ cell tumours, 40-45% of these are seminomas which have the highest incidence in the 30-45years age group, whilst the others are teratomas, the highest incidence of these being in the 20-35 years age group. Occasionally, these tumours are mixed seminoma and teratoma.

Higher incidence in Caucasians than other ethnic groups).

Risk factors include patients that had an undescended testicle, carcinoma in situ (benign condition often found during fertility investigations and has 50% risk of becoming malignant), fertility problems (low semen concentration or abnormal sperm), previous testicular cancer, family history of testicular cancer, HIV and AIDS.

Symptoms may include:

  • Swelling or lump in a testicle, usually painless but swelling may increase and cause pain.
  • Dull ache/pain/ heaviness in scrotum.
  • Pain in the back, groin or lower abdomen.
  • Nipple/breast tenderness or swelling due to hormones being produced by the tumour.
  • Cough, breathlessness, difficulty in swallowing if spread to the lungs (late stage).

Diagnosis

Investigation may include:

  • Physical examination.
  • Blood tests (will include checking hormone levels- alpha feta protein AFP, human chorionic gonadotrophin HCG, lactate dehydrogenase LDH) Ultrasound scan MRI scan- may be requested if ultrasound scan is inconclusive Removal of the testicle (orchidectomy)- the testicle will be removed ad sent for histology if investigations prove highly suspicious of cancer. A biopsy is considered unsafe as this would lead to a high risk of spread.

Treatment

Depends on several factors:

  • The type of tumour.
  • The stage of the cancer.

Surgery

Surgical removal of the testicle will have been performed to confirm histology, in early stage disease where the tumour is contained within the testicle; no further treatment is usually required.

If the disease has spread to the local lymph nodes, additional treatment will be required, for seminomas this may be radiotherapy or possibly chemotherapy. Teratomas and mixed tumours are more aggressive and will require chemotherapy.

Radiotherapy

Post-operative radiotherapy may be advised for seminomas that have spread to some of the local lymph nodes.

Chemotherapy

Chemotherapy would be recommended for all seminoma tumours that have spread to local lymph nodes and for all teratoma/mixed tumours that have spread outside of the testicle. It will be advised for all tumours where the disease has spread to lymph nodes in the chest or higher and if it has spread to other organs.

Make an enquiry

Contact us using our online form, and we'll do what we can to help.

Find a consultant

Specialist Cancer Consultant

We work with some of the UK's leading consultant surgeons, oncologists, and radiologists - find one with the expertise you need.

DIBH

Deep Inspiration Breath-hold Brochure

Download the GenesisCare deep inspiration breath-hold brochure.

GenesisCare

On 8th January 2016, we changed our name to GenesisCare.