Uro-oncology refers to the treatment for urological cancers, ranging from kidney, ureter, bladder, prostate and testes cancers. Surgical approaches for treatment of urological cancers include open, laparoscopic or robot-assisted surgery. For selected cases, local ablative therapy may also be an option. We refer patients who require non-surgical interventions like radiotherapy or chemotherapy to the National Cancer Centre in Singapore for further management.
The most common symptom of bladder cancer is haematuria, otherwise known as blood in the urine. Standard investigations such as urine tests, CT scans and endoscopy of the bladder are usually done to diagnose this and it allows for early detection and treatment. Superficial bladder cancers are usually managed with endoscopic surgeries. Recurrence is significantly reduced by instillation of medication into the bladder of selected patients.
Muscle-invasive bladder cancers are not as common as superficial bladder cancers. These patients require removal of the bladder with urinary diversion (e.g. ileal conduit, orthotopic bladder neobladder, Mitrofanoff procedure). The department has the capability to carry out bladder reconstruction surgery tailored to meet the individual patient’s needs, so as to enhance quality of life. Some patients, for whom surgery may not be an option, may be referred for radiotherapy.
Patients with kidney cancers may present with haematuria or an abdominal mass. Diagnosis is usually made or confirmed using CT scans. If the cancer has not spread, then the options of partial nephrectomy (removal of the cancerous tumour only in selected patients) or radical nephrectomy (removal of affected kidney) could be offered. In recent years, partial nephrectomy using the minimally invasive surgical approach (i.e. robot-assisted or laparoscopic) has emerged as a preferred approach for early kidney cancers in our department. The main advantage of a partial nephrectomy is the preservation of as much kidney function as possible after surgery.
Prostate cancer is now the third most common type of cancer affecting Singapore males, and this incidence has been increasing steadily over the past three decades. The use of prostate specific antigen (PSA) has revolutionised the management of prostate cancer in terms of early prostate cancer detection, prognostication and follow-up. Most importantly, PSA resulted in the diagnosis of more cases of early prostate cancer, which are potentially curable. Diagnostic procedures include transrectal ultrasound, biopsy of prostate and MRI-ultrasound fusion biopsy of prostate.
Each patient with prostate cancer is carefully evaluated and the appropriate treatment is individually tailored to the patient. Robot-assisted Radical Prostatectomy is currently our usual surgical approach as studies have shown better oncological and functional outcomes when compared to laparoscopic and open approaches.
External beam radiotherapy ( beam therapy) is an alternative option for patients with organ-confined prostate cancer, who are unsuitable for surgery or who are not keen for surgical treatment. These patients are referred to the radiation oncologist at the National Cancer Centre Singapore.
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