Bladder Cancer

There were approximately 540,000 cases of bladder cancer and 190,000 deaths related to bladder cancer worldwide. Approximately 79,000 cases occur in the United States each year, and result in approximately 17,000 deaths. The highest rates of bladder cancer, however, are found in Europe, North America, Western Asia and Northern Africa. Factors that increase the risk of urothelial cancers include a history of pelvic irradiation, exposure to cyclophosphamide, and exposure to chemical carcinogens (in cigarettes). In Middle Eastern and African countries, chronic bladder infection accounts for ½ of bladder cancer cases. Bladder cancer is more worrisome than urothelial cell carcinoma and carries a worse prognosis. Risk factors for bladder cancer also include male sex, older age, Caucasian race, and personal or family history of bladder cancer. Men are more frequently diagnosed with bladder cancer compared to women with approximately 80% of cases diagnosed in individuals 60 years of age or older. Groups of individuals with a higher risk of developing bladder cancer include older men and older men who have a history of smoking and workers with occupational exposure to carcinogens. More intensive and regular screening and testing is warranted for individuals who make up this high-risk group. are risk factors for bladder cancer and this demographic is a target for screening. Bladder Cancer The most frequently diagnosed cancer of the urinary tract (other than prostate cancer) is Urothelial Cell Carcinoma. The majority of bladder cancers are non-invasive when they are diagnosed early, however high-grade muscle invasive disease can result from delayed diagnosis. High-grade muscle invasive disease can progress quickly, spread and become fatal. Early diagnosis of bladder cancer can be achieved through screening of the bladder and treatment can lead to cure, prolonged survival and a significant improvement in quality of life. The recurrence of urothelial cancer is an issue for this disease and surveillance (ongoing testing) can enable early future detection.

Prostate Cancer

Prostate Cancer American Guidelines recommend that men under 40 years of age do not have PSA screening. This age group demonstrates the lowest prevalence of prostate cancer. Further, routine screening is not recommended for men aged between 40 and 54 years of age with average risk. High risk individuals under age 55 are those who have a familial history of prostate cancer or of African American race. Those who fall within this category should consult a health care practitioner for individualised prostate cancer screening. For men aged between 55 and 69 years of age, the decision to undertake PSA screening should be based upon weighing the benefits of preventing prostate cancer mortality again the known harms associated with screening and treatment. Despite this, mean aged 55 to 69 years appear to have the greatest benefit of PSA screening. Bi-annual screening may be preferred over annual screening for men who decide to proceed with PSA screening. The baseline PSA level can be used to accommodate individualised intervals for rescreening. For men 70 years and over, who have a life expectancy between 10 and 15 years are not recommended to undertake PSA screening. However, for men of the same age with excellent health are likely to benefit from regular prostate cancer screening.

Australian Guidelines have a focus on early detection of prostate cancer and hence regular PSA screening is recommended. Evidence suggests that PSA testing in men aged 50 to 69 years reduces the incidence of metastatic prostate cancer. PSA testing, however, should not be undertaken independently. Instead, PSA testing should be considered part of a multivariable approach for early detection of prostate cancer. For men in their 40’s, baseline PSA testing is useful in predicting future risk of prostate cancer. Regardless of age, men who have a life expectancy of more than 10 years, and in good health, should not be denied PSA testing.