The urology system (sometimes known as urinary tract) is the body’s system that gets rid of waste, keeps a check on blood volume and keeps a check on your blood pressure. The urology system includes your kidneys, ureters (pipes from the kidney to the bladder) bladder and urethra (the pipe leading urine/wee from the bladder and out of your body). Cancer can grow in each of these areas. The urology team also look after cancers of the prostate and testes which are linked to this system.

The majority of urologic cancers that are detected are found at early stages, when they are still in the organ. Diagnosing and treating cancers at an early stage can help improve good outcomes for patients. Cancers of the urinary tract (or urologic cancers) may be linked to environmental, lifestyle, genetic and other factors. Over the years, methods for finding and treating cancers have improved, and patients are now offered a range of options to suit their goals and needs.

Please select a box below for more information. Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail.

The bladder is a hollow and muscular organ that collects and stores urine (wee). In the UK, over 10,000 people are diagnosed with bladder cancer each year. Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the near by muscles.

The most common symptom of bladder cancer is blood in your wee, which is usually painless. 

The most useful test to diagnose bladder cancer is a cystoscopy which is when a thin tube with a light on is put into your bladder, the doctor or nurse doing the test will take a close look at your bladder and make take a biopsy (small sample of the tissue).

Treatment of bladder cancer depends of the type of cancer you have. For non-muscle-invasive bladder cancer a surgical technique called transurethral resection of a bladder tumour (TURBT) is used to remove the cancer cells, followed by a dose of chemotherapy medication directly to the bladder.

Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a cystectomy. As an alternative to removing the bladder, or if surgery is not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own or combined with radiotherapy.

Kidney cancer, also called renal cancer, is one of the most common types of cancer in the UK. It usually affects adults in their 60s or 70s. It is rare in people under 50. It can often be cured if it's found early. 

Prostate cancer starts in the cells of the prostate. The prostate is a small gland that is just below the bladder and in front of the rectum (back passage).

What are the different types of prostate cancer?

  • early prostate cancer (or localised prostate cancer) – the cancer is only inside the prostate gland
  • locally-advanced prostate cancer – the cancer has spread through the capsule surrounding the prostate gland and may have started to spread into tissue or organs close by
  • advanced prostate cancer (or metastatic prostate cancer) – the cancer has spread to other parts of the body, such as the bones.

If you are a trans woman or are non-binary assigned male at birth, you also need to be aware of prostate cancer.

What are the symptoms of prostate cancer?

Prostate cancer symptoms only happen when the cancer is large enough to press on the tube that carries the urine from the bladder (urethra). If the cancer is in the early stage it may not cause any symptoms.

The prostate gland can also become enlarged due to a prostate condition called benign prostatic hyperplasia (BPH), which is non-cancerous.

The symptoms of benign (non-cancerous) prostate conditions and prostate cancer are similar. They can include:

  • needing to pee more often than usual, especially at night    
  • difficulty peeing – for example, a weak flow or having to strain to start peeing
  • feeling like you have not completely emptied your bladder
  • an urgent need to pee
  • blood in your urine or semen
  • rarely, pain when peeing or ejaculating.

If you have any of these symptoms, it is important to have them checked by your doctor.

What are prostate cancer risk factors?

Age

This is the strongest risk factor for prostate cancer and your risk increases from the age of 50. It is uncommon under the age of 50 and more common over the age of 65. Risk factors like ethnicity and family history are linked with getting prostate cancer at a younger age.

Ethnicity

If you are Black, you have a much higher risk of developing prostate cancer. The reason for this is not clear, but it may be because of genetic factors. You are also more likely to develop prostate cancer at a younger age. If you are Black and aged 45 or over, Prostate Cancer UK has more information about your risk. It gives advice on talking to your GP about your risk of getting prostate cancer and helps you to make  decisions about having a PSA test. If you are Asian, your risk of prostate cancer is much lower. We do not know why this is.

Family history

Sometimes there may be a possible family link (inherited). The risk of prostate cancer is higher if you have: 

  • either a father or brother who had prostate cancer – the risk is greater if they were diagnosed under the age of 60
  • 2 or more close relatives (father, brother, grandfather, half-brother, uncle) on the same side of the family who had prostate cancer
  • a mother who had breast cancer
  • inherited certain cancer gene changes (mutations).

Body weight and diet

Being very overweight (obese) may increase the risk of having a more advanced prostate cancer. It may also increase the risk of having a faster-growing type of prostate cancer. Eating a balanced diet and doing regular physical activity will keep you at a healthy weight.

The PSA (Prostate-specific antigen) test is a blood test. Used with other tests it can help doctors diagnose prostate cancer. PSA is a protein made in the prostate gland. Some PSA leaks into the blood and can be measured in a test. A small amount of PSA in the blood is normal. If the prostate becomes enlarged, inflamed, or infected, larger amounts of PSA get into the blood. The amount of PSA in the blood may also increase if there is cancer in the prostate. A raised PSA level may be a sign of prostate cancer, but it can also be caused by other things, such as non-cancerous prostate conditions.

Who can have the PSA test?

If you are over 50, you can ask your GP for a PSA test. GPs do not routinely offer PSA testing as part of a general health check, or if you do not have any symptoms.If you ask for a PSA test, your GP will advise you to think carefully about the benefits and disadvantages. If you have a higher risk of prostate cancer, it is important to talk to your GP about your personal risk. This is even if you do not have any symptoms. Early prostate cancer does not usually cause symptoms. Talking to your GP can help you to make an informed decision about having a PSA test.

If you are transgender

People who have a prostate include men, transgender (trans) women and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you will still have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have any symptoms and want to have the PSA test.

Is there a national screening programme for prostate cancer?

Screening is a way to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel, and cervical cancer, but no UK national screening programme for prostate cancer. The PSA test on its own is not  accurate enough to be used in a screening programme to diagnose early prostate cancer. It may falsely diagnose prostate cancer and may also miss some cancers. Some studies show that lives may be saved by PSA screening because it may lead to prostate cancer being diagnosed at an early stage. But they also show that screening may lead to:

  • more invasive tests, such as a prostate biopsy, which can cause complications
  • more treatment of slow growing prostate cancers that would never have caused serious harm.

Treatment side effects include:

  • urinary incontinence
  • bowel problems
  • or difficulty getting an erection.

For a screening programme to be effective, the benefits need to outweigh the disadvantages.

Why a PSA test is done

The PSA test may help to diagnose very early prostate cancer before any symptoms develop. There are benefits and disadvantages of having treatment for early prostate cancer. Sometimes a PSA test can lead to an earlier diagnosis of prostate cancer, when treatment to cure the cancer could be more effective. This is particularly the case if you have higher risk factors of prostate cancer.Some prostate cancers grow very slowly. With early prostate cancer, you are not likely to die from it within the next 10 years. For some people, the possible side effects of treatment may be worse than the effects of the cancer itself. You may decide you do not want to know if you have prostate cancer because of the anxiety or uncertainty it might cause you. You may not want further tests, or to make difficult decisions about treatment. Or you may have concerns about the side effects of treatment. Some treatment for prostate cancer may cause urinary incontinence or bowel problems, or affect your ability to get an erection.

Having the PSA testIf you decide to have the PSA test, your GP or nurse will take a blood sample which is then sent to a laboratory for testing. You can ask how long the result will take. If you are having the PSA test, you usually have a rectal examination as well. The doctor gently inserts a gloved finger, using lubricating gel, into your back passage (rectum) to feel the prostate. It may be uncomfortable, but it is quick and should not be painful.

PSA test results

There is not one normal PSA level for everyone. The PSA level naturally gets higher as you get older and varies depending on the size of your prostate. The size of the prostate is different for everyone and the prostate also gets bigger with age. There are different things that can affect the PSA level, for example, non-cancerous prostate problems or a urine infection. Hospitals may have normal ranges for PSA testing based on age, but they do not consider all these other factors.

What is a normal PSA level?

Your GP will think about different things when assessing the results of your PSA test. They will tell you if they think your PSA result is higher than it should be for your age and situation. PSA is usually measured in nanograms per millilitre of blood (ng/ml). If your PSA level is, for example, 3 ng/ml or higher (depending on your age and situation), you may be referred to see a specialist.  Or your GP may recommend repeating your PSA test in a few weeks. A continuous rise in PSA level over time may also be a sign of prostate cancer. A normal PSA level does not mean you will never get prostate cancer. Sometimes prostate cancer can be present even when PSA levels are lower.

Prostate conditions that can affect PSA levels

Different things other than prostate cancer can also raise PSA levels, these includes common prostate conditions, such as:

  • benign prostatic hyperplasia (or hypertrophy) called BPH for short
  • prostatitis (inflammation of the prostate). 

BPH and prostatitis can both cause a raised level of PSA in the blood, but they are not prostate cancer.

  • benign prostatic hyperplasia (BPH)
  • prostatitis

Other reasons for a raised PSA

There are some situations where PSA levels can be raised for a short while. These may affect how accurate the test result is. If you decide to have the PSA test, your doctor may suggest you wait for a while if any of the following apply to you:

  • urine infections
  • recent ejaculation (within the last 48 hours)
  • having a tube in your bladder to drain pee (urinary catheter)
  • recent prostate biopsies
  • prostate or bladder surgery
  • exercising energetically 48 hours before the test (some doctors include cycling in this advice)
  • receiving anal sex or prostate stimulation during sex (best to avoid for 1 week before the PSA test).

If you have the PSA test, always tell your GP/nurse about any medicines you are taking. This includes ones you buy over the counter, complementary therapies or drugs made from herb and plant extracts.

Seeing a specialist

You will usually be seen within 2 weeks of your GP making a referral. The specialist will talk to you about having a specialised scan called a multi-parametric MRI scan. Depending on the results of your scan your doctor may:

  • explain that you do not need any further tests
  • ask you to think about having a prostate biopsy.

Before a biopsy your specialist doctor will explain the risks and benefits to help you to decide. If you have prostate cancer, your specialist will talk to you about your options. 

Questions to think about

Deciding whether to have the PSA test can be hard. Thinking about what is important to you can help you make the best decision. You could think about the following questions:

  • What would you do if your PSA level is raised?
  • What would you do if further tests find that you have early prostate cancer?
  • What difference will it make for you to know about an early prostate cancer?         

We understand that it is important you feel prepared and informed regarding treatment for your prostate cancer. You may have lots of questions regarding the treatment and potential side effects of treatment. Your clinical consultant & their team will be able to answer any specific questions regarding your treatment.

Testicular cancer is cancer that happens in the testicle. The testicles produce sperm. They also produce the hormone testosterone when you go through puberty – the time when your body develops and changes as you become an adult.

Types

The main types of testicular cancer are non-seminoma, which is more common in young people, and seminoma. If you or your child has been diagnosed with a different type of testicular cancer, talk to your specialist for more information about that particular type of cancer and its treatment. 

Symptoms

The most common symptoms of testicular cancer are a painless lump or swelling in the testicle, a painful or heavy feeling in the scrotum (the sac that holds the testicles) or a change in the shape  or feeling of the testicle.

How is it treated?

Treatment for testicular cancer normally involves surgery and chemotherapy. Your exact treatment will depend on the stage and type of your tumour though, so it’s best to talk to your specialist for further information.

You normally have the affected testicle removed during an orchidectomy while going through diagnosis. If you’ve only had one testicle removed, this won’t affect you or your child’s ability to have children. It’s not common to have both testicles removed, but if they are, you won’t be able to have children. In both cases you’ll still be able to have sex.

Chemotherapy, which uses anti-cancer drugs to kill cancer cells, is usually given as an injection or through a drip every 3–4 weeks for four or more sessions of treatment. A course of radiotherapy, where radiation is used to kill cancer cells, may also be used.

How is it diagnosed?

If your GP thinks you need to have further tests, you’ll normally be sent to the hospital where a specialist will give you an ultrasound scan of your scrotum and testicles to check for anything unusual. You will normally also have blood tests to check if any hormones produced by testicular cancer, known as ‘markers’, are present. If the tests show that you, or your child, are likely to have testicular cancer  – in the form of a tumour, or lump – you will normally have an operation to confirm the diagnosis.

The operation will remove the whole of the affected testicle and is known as an orchidectomy.You may have further tests if your specialist thinks your cancer might have spread. The specialist will be able to work out the stage of cancer from these tests. The stage is the size of the tumour and whether it has spread to other parts of your body.

After treatment

Your specialists will do everything they can to keep your ability – or your child’s ability – to have children.But the most important thing will need to be fighting the cancer.

If your or your child’s treatment for testicular cancer does affect your or their ability to have children, it’s important you talk this through with your specialist or nurse.

You will still need to attend an outpatient clinic regularly so your specialist can check your progress and make sure your cancer hasn’t come back. This is known as surveillance, or monitoring. Many people don’t have long-term health problems following treatment, but some do. Talk to your specialist about the potential long-term side effects of your treatment.

How your sex life, sexuality, relationships and fertility is impacted by cancer.

Read more on the links below:

Penile cancer (cancer of the penis) is rare. Nearly all cancers of the penis are squamous cell cancers. Squamous cells are found in the skin. They cover the surface of most parts of the body. Rarely, other types of cancer can affect the penis. These include types of skin cancer such as basal cell carcinomas and malignant melanomas. Most penile cancer is diagnosed over the age of 50, it can sometimes also affect younger men.

Symptoms

Signs and symptoms of penile cancer can include:

  • a growth or sore (ulcer) on the head of the penis (the glans), the foreskin or the shaft
  • changes in the colour of the skin, such as a redness, white patches or areas that look blueish, brown or black in colour
  • discharge or bleeding
  • pain, a lump or discharge underneath the foreskin, this is usually only seen if the foreskin is pulled back.

These symptoms can also happen with other conditions, however always see your GP straight away if you have any of these symptoms or any other changes. Penile cancer is easier to treat if it is diagnosed early.

The exact cause of penile cancer is not known. Penile cancer is not infectious and cannot be passed on to other people.

Diagnosis

If you have any symptoms, make an appointment to see your GP. If your GP thinks that your symptoms could be caused by cancer they usually refer you to a doctor called a urologist. A urologist specialises in urinary or genital problems.  He will ask you about your symptoms, and examine the penis and check the area at the top of the legs (groin) for any swellings.

The doctor will take a sample of tissue (a biopsy) from any abnormal or sore-looking area on the penis to diagnose if you have penile cancer.The specialist team will arrange further tests. These are to find out whether the cancer is only in the penis or if it has spread. The results help your specialist team plan the best treatment for you.

Click here to read more about diagnosis and click here to read about treatment.

After penile cancer treatment

After your treatment, you will have regular follow-up appointments with your surgeon or cancer specialist. They will examine you and you may have blood tests or scans. This may continue for five years If you have any problems, or notice any new symptoms between appointments, let your doctor know as soon as possible.

Relationships and sex: Your doctor or nurse will explain any possible effects your treatment may have on your sex life. If you have an early-stage cancer, treatment is unlikely to directly affect your sex life.It is usually safe for you to have sex as soon as the treated area has completely healed and you feel ready. Your doctor or nurse will give you advice on this.

Late effects after treatment: Some men may get side effects months or years after radiotherapy treatment. These are called late effects.After radiotherapy, the healthy tissue in the penis may get thicker. This can cause narrowing of the tube that carries urine through the penis (the urethra). If this happens, you may find it difficult to pass urine. This can be treated with a simple operation to stretch the urethra. If you have difficulty passing urine, tell your doctor straight away.We have more information about the late effects of pelvic radiotherapy for men.Organisations such as Orchid offer more information and support for people with penile cancer.

Well-being and recovery: Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.The blue highlighted in the document takes you to the Macmillan support website to see more detailed information.

Tests and Scans
Treatment
Symptom Management
Health and Wellbeing
Palliative Care
Patient Stories