12 Types of Common Cancers in Men (With Screening)
Signs, Symptoms And Treatment Of Bladder Cancer – Your Questions Answered By Experts
In the last couple of years, Professor Syed Hussain has become increasingly concerned by the growing number of patients presenting with bladder cancer at an advanced stage.
"Since Covid, there has been an issue with patients not managing to get their GP appointments," says Prof Hussain, a professor of medical oncology at the University of Sheffield and an honorary consultant at Sheffield Teaching Hospitals. "And as a result, we are seeing more cases coming in later, once their cancer has become a life-limiting illness."
A recent breakthrough in diagnostics could make it easier to detect patients early. Various NHS trusts are currently evaluating a test developed by Professor Richard Bryan, the director of the Bladder Cancer Research Centre at the University of Birmingham, and his team called Galeas Bladder which detects signs of cancerous DNA in the urine and can diagnose the disease with 90 per cent accuracy.
So how does bladder cancer develop and what are the most common causes?
What is bladder cancer?Bladder cancer is defined as abnormal cancerous growths which arise from cells in the bladder. More than 90 per cent of all bladder cancers are known as transitional cell carcinomas, which arise from the layers of urothelial cells which line the bladder and the rest of the urinary tract. Urothelial cells are particularly specialised because, unlike many of the other cells which line our internal organs, they help to store fluid – in this case urine which has been excreted from the kidneys – rather than absorbing it back into the body.
"The bladder is designed to be able to expand and contract without damage," says Prof Bryan. "So the bladder lining is quite specialised and slowly regenerates because it doesn't have to deal with the same amount of local trauma as the gut, for example. But it's from this lining where bladder cancers arise."
However, there are also some other rare forms. Around 5 per cent of patients have metaplastic cancers, which tend to be caused by chronic inflammation, either from a chronic urinary tract infection, long-term catheter implantation for severely disabled patients or water-borne parasites. This causes normal cells to morph into different types of cells which can become cancerous.
How common is bladder cancer?Approximately 21,185 people in the UK are diagnosed with the disease every year according to statistics from the charity Fight Bladder Cancer. "This puts it right up there as quite a common cancer, and probably the fourth or fifth most common cancer in men," says Prof Bryan.
Like many cancers, the severity depends largely on how swiftly it is caught. Prof Bryan estimates that up to 80 per cent of patients are diagnosed at a stage where the cancer can still be sent into remission. However, once the disease has penetrated the bladder muscle layer, the prognosis deteriorates rapidly, with five-year survival rates of just 50 per cent.
The different categories of bladder cancerThe vast majority of bladder cancer research has focused on transitional cell carcinomas. Most patients have non-muscle invasive cancer, in which the tumours are either still confined to the bladder lining or the layer immediately beneath. Prof Bryan explains that they are then categorised as either low risk, intermediate risk, high risk or very high risk, depending on how aggressive the cancer appears to be.
"This is determined by the number of tumours a patient has, because bladder cancers frequently involve multiple tumours, and also the size of the tumours," says Prof Bryan.
However, there is also an even more serious form of the disease in which the tumours have progressed beyond the bladder lining and into the muscle.
What causes bladder cancer?Around half of all bladder cancers are directly linked to the ingestion of toxic chemicals known as aromatic amines and polycyclic aromatic hydrocarbons, which are abundant in industrial and manufacturing plants and diesel exhaust. "If we go back to the history of bladder cancer, it was often linked to people who had worked for decades in synthetic dye manufacturing plants as well as tyre manufacturing and rubber manufacturing," says Prof Bryan.
However the biggest contributor of all to bladder cancer is smoking, which is associated with 40 per cent of transitional cell carcinomas. Cigarette smoke is rich in aromatic amines and polycyclic aromatic hydrocarbons, which are absorbed through the lungs and into the bloodstream. The liver metabolises these chemicals which are then excreted into the bladder via the kidneys.
"They react with other constituents of the urine and are almost reactivated as carcinogens," says Prof Bryan. "So you have your urine sitting in your bladder for hours on end, containing potential carcinogens which can damage the DNA in those urothelial cells lining the bladder, starting the process of transformation to malignancy. If you're a 20-a-day smoker and have been for 10 years, you have four times the risk of developing bladder cancer than somebody who's never smoked."
The other major risk factor for bladder cancer is simply being male. Three times more men develop the disease compared to women, and Prof Bryan's research group is trying to understand why this is the case, and whether it could point towards future therapeutic options.
"This is mere speculation, but perhaps females have some sort of inherent protection from bladder cancer," says Prof Bryan. "It could be hormonally related. In all likelihood it will ultimately be related to how the immune system works, and immune surveillance of bladder cells that have gone rogue is better in females than it is in males. But these are just hypotheses."
What are the symptoms?Oncologists estimate that between 60 per cent and 80 per cent of patients diagnosed with bladder cancer have visited their doctor after seeing blood in their urine, a symptom known as hematuria.
"That's quite an important sign not to miss," says Prof Hussain. "Not every hematuria will be bladder cancer, it can also be related to urinary infections, but it could be an early manifestation of cancer. People seeing this should present to their GP and then be referred to urology services where hospitals have a one-stop clinic doing imaging scans for anyone who presents with hematuria."
How is bladder cancer diagnosed?For many years, bladder cancer has been diagnosed through flexible cystoscopy, a test in which a thin, fibre-optic tube is passed through the urethra and enables the doctor to look directly at the lining of the bladder.
However, this has a number of limitations, from discomfort for patients, to the number of trained specialists required to perform the examination. If NHS evaluations confirm that the Galeas Bladder urine test is comparable to flexible cystoscopy, it could be rolled out on a national scale.
Simon Crabb, a professor of experimental cancer therapeutics at the University of Southampton, says that if urine-based tests are proven to be sufficiently accurate, they could be utilised as part of screening programmes in future.
"We don't have a screening test for bladder cancer at the moment," says Prof Crabb. "A lot of advice around early detection is about people recognising blood in the urine. Many patients will have something perfectly benign, but it's the best way at the moment to detect it at an early stage. Bladder cancer and urine-based tests make sense, and that may be the way to go."
Any patient diagnosed with bladder cancer, even at an early stage, will have to get used to regular ongoing surveillance. "For patients who've been treated for early bladder cancer, their management will rely on monitoring by a camera (cystoscopy) inspection," says Prof Bryan. "Some patients will be having that every three or six months, for many years."
How is it treated?There are four different stages.
Patients with early-stage bladder cancer can usually be managed effectively with a form of immunotherapy known as Bacillus Calmette Guérin (BCG) which is administered directly into the organ via a catheter. Prof Hussain says that in many cases, this can effectively manage the cancer and send it into remission, and surgery is only considered in instances where the cancer has penetrated into the muscle.
In the 20 to 25 per cent of patients who have muscle-invasive bladder, there are two main options, either chemotherapy followed by surgery or chemoradiotherapy. The latter case is an alternative to removing the bladder in an operation and involves having chemotherapy and radiotherapy treatment together in order to sensitise the cancer cells to radiotherapy.
However, just under one in 10 patients are found to have advanced or metastatic bladder cancer, which has not just penetrated the bladder muscle but spread beyond the bladder into other organs.
"Here, treatments will unfortunately be not curable but only palliative," says Prof Hussain. "But in metastatic cancer, the treatment landscape has significantly changed and there's a lot more hope. There are a number of new drug options, patients are living longer and they're staying well."
Prof Hussain says that while the average survival rate for a patient with metastatic bladder cancer used to be between 12 and 18 months, this has now increased to between 24 and 30 months in the last few years, particularly with the advent of a new class of drugs called immune checkpoint inhibitors which are administered into the bloodstream through a drip. These drugs are now available on the NHS as a standard of care.
More recently, clinical trials of immune checkpoint inhibitors in combination with another class of drugs called antibody-drug conjugates have shown promising results in improving survival outcomes for patients with metastatic bladder cancer.
"You can only really give six cycles of chemotherapy, for around three to four months, because then the patient's bone marrow starts to crack," says Prof Hussain. "But immune checkpoint inhibitors are very clever drugs, using your own immune cells to find camouflaged cancer cells and attack them."
A new clinical trial is testing whether it is safe to administer immune checkpoint inhibitors directly into the bladder in patients with early-stage cancer, to see whether this can treat their cancer more effectively. Prof Hussain is currently involved in a trial which is looking at a particular immune checkpoint inhibitor called atezolizumab in patients with non-muscle invasive cancer, for whom BCG has not worked, or people who have muscle-invasive cancer but are not well enough to undergo chemotherapy.
"I think it's important to highlight the hope that we are seeing," says Prof Hussain. "Patients are living longer, and with good quality of life which is all down to these new drugs."
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Understanding Prostate Cancer -- The Basics
The prostate is a gland in the male reproductive system. It makes most of the semen that carries sperm.
It sits directly beneath your bladder and in front of your rectum. Because the first portion of the urethra passes through the prostate, the passage of urine or semen through the urethra can be blocked if the gland is enlarged.
Prostate cancer is a malignant tumor of the prostate.
The disease is less common before age 50, and experts believe that most elderly men have traces of it.
African American men are more likely to get prostate cancer and have the highest death rate. Other than skin cancer, prostate cancer is the most common cancer in American men. In other parts of the world -- notably Asia, Africa, and Latin America -- prostate cancer is rare.
Prostate cancer is usually a very slow-growing cancer, often causing no symptoms until it is in an advanced stage. Most men with prostate cancer die of other causes and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads outside the prostate, it is dangerous.
Prostate cancer in its early stages (when it's found only in the prostate gland) can be treated, with very good chances for survival. Fortunately, about 85% of American men with prostate cancer are diagnosed in an early stage of the disease.
Cancer that has spread beyond the prostate (such as to the bones, lymph nodes, and lungs) is not curable, but it may be controlled for many years. Because of the many advances in treatments, most men whose prostate cancer becomes widespread can expect to live 5 years or more. Some men with advanced prostate cancer live a normal life and die of another cause, such as heart disease.
Prostate cancer affects mainly older men. About 80% of cases are in men over 65, and less than 1% of cases are in men under 50. African American men and those with a family history of prostate cancer are more likely to get it.
Doctors don't know what causes prostate cancer, but diet contributes to the risk. Men who eat lots of fat from red meat are most likely to have prostate cancer. Eating meat may be risky for other reasons: Meat cooked at high temperatures produces cancer-causing substances that affect the prostate. The disease is much more common in countries where meat and dairy products are common than in countries where the diet consists of rice, soybean products, and vegetables.
Hormones also play a role. Eating fats raises the amount of testosterone in the body, and testosterone speeds the growth of prostate cancer.
A few job hazards have been found. Welders, battery manufacturers, rubber workers, and workers frequently exposed to the metal cadmium seem to be more likely to get prostate cancer.
Not exercising also makes prostate cancer more likely.
Drugs that may lower the risk of prostate cancer include aspirin, finasteride (Proscar), and dutasteride (Avodart).
There's no evidence that you can prevent prostate cancer. But a few simple things may help lower your odds.
Healthy food
A diet that helps you stay at a healthy weight may cut your chances of having prostate cancer. These steps can help:
Antioxidants in foods, especially in fruits and vegetables, help prevent damage to the DNA in your cells. Such damage has been linked to cancer. Lycopene, in particular, is an antioxidant that has been thought to lower the risk of prostate cancer. It can be found in foods such as:
Frequent ejaculation
Whether it's from sex, masturbation, or wet dreams, men who ejaculate more appear to be less likely to get prostate cancer. Doctors aren't sure why it helps, but they think it may help move potentially irritating substances out of the prostate.
Symptoms of prostate cancer include:
Doctors use two tests to look for prostate cancer: a digital rectal exam and a PSA blood test.
The PSA blood test looks for prostate-specific antigen in the blood. Experts are divided on who should have a PSA test and when to have it:
PSA levels in blood are higher if there is prostate cancer, making it a valuable tool in finding early prostate cancer. But PSA levels can also be high from infection or inflammation in the prostate or from an enlarged prostate.
It's important to discuss this test with your doctor before you have it. A high PSA level does not mean you have cancer; a normal PSA level does not mean you don't have cancer.
If PSA levels are high or have gone up since your last PSA test, your doctor will do a biopsy of the prostate gland using a small ultrasound probe inserted in the rectum (transrectal ultrasound). Tissue samples will be tested for cancer.
If cancer is found, the doctor may do abdominal and pelvic X-rays to see if the cancer has spread outside the prostate. You may also have an MRI and a bone scan.
If you have high PSA levels but biopsies don't find cancer, a urine test known as a PCA-3 looks for cancer. This can prevent the need for repeat biopsies in some men.
If you need treatment, your doctor will decide the type. Decisions about how to treat this cancer are complex, and you may want a second opinion before making a treatment decision. Treatment may include watchful waiting, a single therapy, or some combination of radiation, surgery, hormone therapy, and less commonly chemotherapy. The choice depends on many things. Prostate cancer that hasn't spread usually can be cured with surgery or radiation.
Watchful waiting
Since prostate cancer can grow slowly and may not be fatal in many men, some patients -- after discussing the options with their doctors -- opt for "watchful waiting." This means not treating it. Instead, the doctor regularly checks the prostate cancer for signs that it is becoming more aggressive. Watchful waiting is typically recommended for men who are older or have other life-threatening conditions. In these cases, a less aggressive cancer may be growing so slowly that it's not likely to be fatal.
Surgery
The standard operation, a radical retropubic prostatectomy, removes the prostate and nearby lymph nodes. In most cases, surgeons can remove the gland without cutting nerves that control erections or the bladder, making impotence or incontinence much less common than in the past. Depending on the man's age and the amount of surgery needed to remove all the cancer, nerve-sparing operations allow many men who were able to get erections before surgery to be able to do so after surgery without the need for erectile dysfunction treatments.
Laparoscopic robotic prostatectomy is a surgery using a laparoscope aided by robotic arms. This operation is now the most popular form of radical prostatectomy in the United States.
After surgery, most men have temporary incontinence, but they usually regain complete urinary control over time. If it is severe or lasts a long time, incontinence can be managed with special disposable underwear, exercises, condom catheters, biofeedback, penile clamps, implants around the urethra, or a urethral sling.
After surgery or radiation, men may have impotence. Treatment includes drugs such as sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn). Other treatments include teaching the man to perform a painless self-injection into the penis (of a drug called Caverject), or vacuum pumps. A penile prosthesis is used only when all other options have failed.
Radiation
Radiation is often the main treatment for prostate cancer that has not spread. It may also be given as follow-up to surgery. Radiation may also be used, in advanced cases, to relieve pain from the spread of cancer to bones. Incontinence and impotence may also happen after radiation. Radiation to the pelvis may also be done if PSA levels rise after surgery.
An advanced form called intensity modulated radiation therapy (IMRT) can increase the dose of radiation to the prostate with fewer side effects to the nearby tissues. Proton beam therapy can increase the dose to the prostate even more. But proton therapy has not been found to be better than IMRT. A more focused form of radiation, stereotactic radiation, is being used for early forms of prostate cancer. This treatment also has not been shown to improve the outcome of prostate cancer. Though it may take less time than IMRT, it may have more side effects.
Radioactive seeds (brachytherapy) deliver radiation to the prostate with little damage to nearby tissues. Your doctor implants the tiny radioactive seeds, each like a grain of rice, in the prostate gland using ultrasound guidance. The implants remain in place permanently and become inactive after many months. In some patients, this method may be used with traditional radiation. Or, if the prostate gland is too large for brachytherapy, hormone therapy can shrink the prostate to allow brachytherapy to be done.
Hormone therapy
Hormone therapy is the recommended treatment for advanced prostate cancer. Since testosterone can make prostate cancer grow, hormone therapy works by tricking the body to stop making testosterone, stopping or slowing the cancer's growth. The following drugs decrease the amount of testosterone being made by the testicles:
Even advanced cases that cannot be cured may be controlled for many years with hormone therapy. But there is a higher risk of heart disease with this treatment. Fractures are also a risk because of thinning bone. Medications can reduce the risk of osteoporosis and fractures.
Testosterone can also be removed from the bloodstream by surgically removing the testicles (orchiectomy) or by giving female hormones such as estrogen or other drugs that block testosterone production. Estrogen therapy is no longer used routinely. Men generally prefer the testosterone-blocking drug treatment because it is effective, is less invasive, and causes fewer side effects than surgery or female hormone drugs.
Other treatments
Chemotherapy is effective for some men with advanced prostate cancer who didn't do well on or respond to hormone therapy. When traditional hormonal treatments stop working, newer hormonal therapies may be considered.
Abiraterone (Zytiga) blocks tissues from making testosterone. Apalutamide (Erleada) and enzalutamide (Xtandi) prevent cancer cells from getting the signal to grow and divide.
Darolutamide (Nubeqa) has been approved to treat those whose cancer has not spread to other parts of the body but has not responded to surgical treatment or standard androgen deprivation therapy (it's used for prostate cancer in men with castrate testosterone levels whose PSA levels continue to rise). This is also known as nonmetastatic castration resistant prostate cancer (nmCRPC).
Biological therapy (immunotherapy) is a treatment that works with your body's immune system to fight cancer or manage side effects from other treatments.
High-intensity focused ultrasound (HIFU) uses high-energy sound waves to kill prostate tissue. But it's not approved to treat prostate cancer itself. Research is ongoing to see how it works.
The goal of prostate cancer treatment is long-term survival, and that is likelier in men diagnosed early. All prostate cancer survivors should be examined regularly and have their PSA and testosterone levels monitored closely.
Although the number of men diagnosed with prostate cancer remains high, so does the number of men who get it and live. Survival rates after diagnosis of common types of prostate cancer are:
Bladder Cancer Treatment
The treatments for bladder cancer are:
MSK also combines these treatments, depending on whether the tumor has grown into the muscle or metastasized (spread). Our goal is to preserve your bladder or rebuild it, if removing it was the best treatment for you. We also aim to keep your quality of life. Before we recommend treatment, you may meet with a surgeon, radiation oncologist, and a medical oncologist (cancer doctor).
Request an Appointment Call 800-525-2225Available Monday through Friday, 8 a.M. To 6 p.M. (Eastern time) The latest in bladder cancer treatmentsImmunotherapy is a newer way to treat bladder cancer. It uses the immune system to attack cancer cells.
Antibody-drug conjugates (ADCs) and checkpoint inhibitors are promising new drugs that have changed how we treat bladder cancer.
Non-muscle invasive bladder cancer (NMIBC) can be treated with surgery followed by bacillus Calmette-Guérin (BCG) therapy. People often come to MSK for BCG treatment after their healthcare provider offered chemotherapy as the only treatment option for high-grade NMIBC.
Bladder Cancer SurgerySurgery is a treatment for bladder cancer that has not spread to other parts of the body. For early-stage cancer, we use transurethral (TRANZ-yoo-REE-thrul) resection of a bladder tumor (TURBT). In this surgery, we remove the tumor using a tool in the cystoscope.
For higher risk bladder cancer, often the best treatment is removing your bladder. This is called a radical cystectomy. We can often create a new bladder at the same time. This is called a neobladder. You will not need a pouch outside your body that collects urine.
Learn about bladder cancer surgery at MSK.
Chemotherapy for Bladder CancerChemotherapy is a treatment that uses a drug or combination of drugs to kill cancer cells anywhere in your body. It often is used after surgery for early-stage bladder cancer that has not grown into the muscle.
The standard treatment for people with metastatic bladder cancer is platinum-based chemotherapy. MSK is now researching a promising treatment that may help people who can't have cisplatin-based chemotherapy. The new approach combines 2 drug classes, antibody-drug conjugates (ADCs) and checkpoint inhibitors.
Learn about chemotherapy for bladder cancer at MSK.
Radiation Therapy for Bladder CancerRadiation therapy uses high-energy beams to treat cancer. It works by harming the cancer cells so it's hard for them to grow.
MSK's radiation oncologists (doctors who use radiation to treat cancer) may use radiation instead of surgery for some bladder tumors. It may also be used after surgery to kill any cancer cells that remain.
At MSK, radiation treatment is guided by very advanced imaging methods that are not available at most hospitals. This includes image-guided radiation therapy (IGRT), which can treat tumors with even more accuracy than regular radiation therapy.
Learn about radiation therapy for bladder cancer at MSK.
Immunotherapy for Bladder CancerImmunotherapy triggers the body's immune system to fight cancer cells.
MSK is leading research on immunotherapy drugs called checkpoint inhibitors. This treatment can be used instead of chemotherapy. It also can be used after chemotherapy has been tried for advanced bladder cancer that has spread. For people who respond to checkpoint inhibitors, the drugs can have a longer impact than chemotherapy, with fewer side effects.
The checkpoint inhibitor called pembrolizumab also can be used for non-muscle invasive bladder cancer (NMIBC). It's for people with NMIBC that has returned and is worse after BCG therapy.
Learn about immunotherapy for bladder cancer at MSK.
Bacillus Calmette-Guérin (BCG) Therapy for Bladder CancerNon-muscle invasive bladder cancer (NMIBC) can be treated with surgery followed by bacillus Calmette-Guérin (BCG) therapy. People often come to MSK for BCG treatment after their healthcare provider offered chemotherapy as the only treatment option for high-grade NMIBC.
This type of immunotherapy is used when there is a high risk of bladder cancer coming back after surgery. It triggers an inflammatory response in your bladder that stops the tumor from growing. BCG is given once a week, for 6 weeks.
Learn about BCG therapy for bladder cancer at MSK.
Clinical Trials for Bladder CancerClinical trials are research studies that test new treatments, procedures, or devices to see how well they work. They are an important part of helping to prevent, treat, and cure cancer. Almost every cancer treatment given to patients was first tested during a clinical trial. MSK patients can join a clinical trial to get treatment options not available anywhere else.
To find a bladder cancer clinical trial that may be right for you, visit our clinical trials page. Go to the "Search by keywords" search bar. Type in "bladder cancer" or the type of bladder cancer, such as:
You'll see a list of clinical trials, and whether they are a pilot or phase 1 to 4. For information on phases and clinical trials, please read Clinical Trials at MSK: What You Need to Know.
Bladder Cancer Follow-Up CareYour time with MSK does not end with your active bladder cancer treatment. Your follow-up care team will continue to support you. They can:
Follow-up care for bladder cancer includes regular exams and tests, such as:
Most bladder cancer treatment is successful. But it's important to be checked for signs of the cancer coming back. You're still at risk for getting bladder cancer. Your care team will monitor you for any signs of cancer.
Tell your care team about any new symptoms. Blood in the urine (hematuria) is often the most common sign. These symptoms can mean the cancer has come back, or another medical condition.
Your bladder cancer follow-up care teamDuring your follow-up care, you will see an MSK advanced practice provider (APP). One type of APP is a nurse practitioner (NP). Your NP has special training in follow-up care for people who had bladder cancer. They will monitor you for signs of cancer and help you manage any side effects after treatment.
A visit with your NP includes:
After each visit, your NP will give a treatment summary and survivorship plan of care. Your treatment team will use this information in your care plan.
Your MSK Follow-Up Provider Why should I choose Memorial Sloan Kettering for bladder cancer treatment?MSK's team of bladder cancer experts
Learn more about why you should choose MSK for bladder cancer treatment.
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