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Clinical Insight

Urological Cancer Assessment & Diagnostics

Specialist investigation and diagnosis of urological cancers in Wrexham, Chester and Shrewsbury

Being told that you need further investigation for a possible cancer can be worrying. However, many symptoms that lead to a cancer investigation have non-cancerous causes.

The purpose of specialist urological assessment is to investigate symptoms or abnormal test results carefully, identify the underlying cause and, where appropriate, arrange further investigations to establish or exclude a cancer diagnosis.

As a Consultant Urological Surgeon specialising in endourology, I provide specialist assessment and diagnostic investigation for suspected prostate, bladder, kidney, testicular and penile conditions in patients across Wrexham, Chester and Shrewsbury.

What are urological cancers?

Urological cancers affect organs of the urinary system and male reproductive system.

These include:

  • Prostate cancer

  • Bladder cancer

  • Kidney cancer

  • Upper urinary tract cancers

  • Testicular cancer

  • Penile cancer

Different cancers present in different ways, and symptoms can overlap with common benign urological conditions.

Symptoms that may require investigation

Depending on the cancer and its location, symptoms may include:

Blood in the urine (haematuria) is an important symptom that should be appropriately assessed, particularly when it is visible and unexplained. NICE guidance recommends suspected cancer pathway referral in specified circumstances, including unexplained visible haematuria in adults aged 45 and over.

Importantly, having one of these symptoms does not mean that you have cancer. Many have benign explanations.

Prostate cancer assessment

Prostate cancer may cause few or no symptoms in its early stages.

Assessment may be considered because of:

  • A raised PSA

  • A change in PSA over time

  • Abnormal prostate examination

  • Urinary symptoms

  • A family history of prostate cancer

  • Other individual risk factors

PSA blood test

PSA is a protein produced by prostate cells.

A raised PSA can occur because of prostate cancer, but also because of conditions such as benign prostate enlargement or prostatitis. A PSA result therefore cannot diagnose prostate cancer on its own.

Prostate examination

A digital rectal examination may be used as part of the assessment of prostate symptoms or suspected prostate cancer.

Multiparametric MRI

If prostate cancer is suspected, multiparametric MRI (mpMRI) can provide detailed images of the prostate and help determine whether a biopsy may be required.

Prostate biopsy

If further investigation is indicated, a prostate biopsy may be recommended.

Small samples of prostate tissue are examined under a microscope to determine whether cancer cells are present.

The decision to perform a biopsy should take into account the PSA, MRI findings, examination and individual circumstances.

Bladder cancer assessment

One of the most important symptoms associated with bladder cancer is blood in the urine.

Other symptoms can include:

  • Urinary frequency

  • Urgency

  • Burning when passing urine

  • Recurrent urinary symptoms

  • Pelvic discomfort

However, these symptoms are also common in conditions such as urinary tract infections and BPH.

Flexible cystoscopy

Flexible cystoscopy is an important investigation when bladder cancer needs to be excluded.

A thin camera is passed through the urethra into the bladder, allowing the bladder lining to be examined directly.

If an abnormal area is identified, further investigation or biopsy may be required.

Urinary tract imaging

Depending on the circumstances, imaging such as ultrasound or CT may be used to examine the kidneys, ureters and bladder.

Kidney cancer assessment

Kidney cancers are often discovered incidentally during imaging performed for another reason, although some patients develop symptoms.

Possible symptoms include:

  • Blood in the urine

  • Persistent pain in the side or back

  • A lump or swelling

  • Unexplained weight loss

  • Persistent fever or night sweats

These symptoms can have many other causes and do not automatically indicate kidney cancer.

Ultrasound, CT and MRI can all have roles in investigating abnormalities of the kidney.

If a suspicious kidney mass is identified, further specialist assessment may be required to establish the nature of the lesion and the most appropriate management.

Testicular cancer assessment

A new lump or enlargement of a testicle should be assessed.

Other possible symptoms include:

  • Change in the size or shape of a testicle

  • Heaviness within the scrotum

  • Persistent testicular discomfort

  • A change in the consistency of the testicle

An ultrasound scan of the scrotum is commonly used to investigate a testicular abnormality.

NICE recommends suspected cancer pathway referral for men with a non-painful enlargement or change in the shape or texture of the testis.

Penile cancer assessment

Penile cancer is uncommon.

A persistent abnormality of the penis should be assessed, particularly:

  • A persistent ulcer

  • A lump

  • An abnormal growth

  • Persistent changes affecting the foreskin

  • An unexplained lesion that does not resolve

Some penile conditions are benign or related to infection or inflammation, but persistent or suspicious lesions may require specialist assessment and biopsy.

Why early diagnosis matters

When a cancer is present, identifying it at an earlier stage can provide more opportunities for treatment.

NHS England has established timed diagnostic pathways for several urological cancers, including bladder, renal, penile and testicular cancers, with the aim of reducing delays and variation in diagnosis.

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