Genitourinary System Cancers

Prostate cancer is the most common cancer in men and the second most common cause of cancer-related death in males with approximately 1.6 million new cases and 366,000 deaths annually. Prostate cancer incidence rates spiked dramatically in the late 1980s and early 1990s due to introduction of prostate-specific antigen (PSA) blood test. Prostate cancer risk factors are increasing age, African ancestry, family history, and certain inherited genetic conditions such as Lynch syndrome and BRCA1 and BRCA2 mutations. Black men have the highest aggressive prostate cancer development risk, whereas Asians are at lowest prostate cancer risk with 30- to 50-fold incidence difference between native Asians and black men. The 5-year relative survival rate for 89% of men with local or regional stage prostate cancer approaches 100% but 30% for those with metastatic disease. The risk of prostate cancer is nearly 10% over the course of life time for men. Testicular cancers constitute 1% of all malignant tumors in young men of age 15–35 years. It is uncommon but one of the most important malignant tumors in young men with worldwide incidence of 55,000 new cases and estimated 10,000 deaths annually. Isochromosome 12p is the prominent characteristic of testicular cancers in more than 80% of cases. Testicular cancer in white men is 5.4 times more than in black men. Testicular germ cell tumors are separated into two subgroups of seminomatous and non-seminomatous germ cell tumors (NSGCTs), whereas mixed type histologies are considered to have NSGCTs. Bladder cancer is the fourth most common cancer in men following prostate, lung, and colon cancers constituting 5–10% of all male cancers, and it is the eighth most common cancer in women. The risk of developing bladder cancer up to 75 years of age is 2–5% in men and 0.5–1% in women. The risk factors are aniline dyes, smoking, pelvic radiotherapy, cyclophosphamide, phenacetin use, and Schistosoma haematobium infections in African and Middle Eastern countries. Urothelial carcinomas are responsible for 90% of bladder cancers in developed countries, and SCC is more common in schistosomiasis-endemic countries. The vast majority of bladder cancer cases are superficial at diagnosis. Grade is the most important outcome predictor for non-muscle invasive tumors, while depth of invasion is important for muscle-invasive tumors. Basic concepts that are crucial to understanding prostate, testicular, and bladder cancers are reviewed in depth in this chapter.