Urologic oncology

ALSO KNOWN AS: Genitourinary oncology

DEFINITION: Urology studies the male and female urinary and male reproductive systems. Oncology is the study of the development, diagnosis, treatment, and prevention of cancer. Urologic oncology diagnoses, treats, and prevents cancers involving the urinary and male reproductive systems.

Cancers treated: Urologic oncologists treat bladder cancer, kidney cancer, penile cancer, and testicular cancer in men and bladder and kidney cancer in women.

Training and certification: Urologic oncologists are doctors who are board-certified in urology. In the hierarchy of medicine, urology is classified as a surgical subspecialty, which means the doctor has specialized training in surgery. Doctors who are American College of Surgeons (FACS) fellows have achieved more advanced surgical qualifications.

To become board-certified in urology in the United States, the doctor must have graduated from an approved medical school and have completed an accredited urology residency program that involved at least five years of training. During the residency training program, the American Board of Urology (ABU) mandates four years in clinical urology, three months of training in general surgery, three months of core surgical training, and at least six months in general surgery, urology, or another specialty relevant to urology. The doctor must be a chief resident in urology for at least twelve months during the last two years of the program.

Within six years of completing the education program, the doctor must complete qualifying and certifying examinations to become board-certified. The qualifying examination consists of a one-day written exam to assess the doctor’s knowledge of the entire field of urology and related subjects. The certification examination is designed to assess clinical competence. During the two-day certification process, the doctor is evaluated to ensure the existence of an approved practice log and a favorable professional reputation among peers. Additionally, the urologist is tested on knowledge in immunology, molecular biology, hypertension, transplantation, sexual dysfunction, urologic imaging, pathology, and problems with urination, such as benign prostatic hyperplasia (BPH) and incontinence. Some questions pertain to infections, inflammatory diseases, fertility problems, obstructive diseases, cancer, anatomy, fluid imbalances, and pediatric urology. To become board-certified, the practicing urologist must have high expertise in these areas. Doctors certified after January 1, 1985, must undergo a recertification process every ten years. Doctors who receive certification must also complete specific requirements to maintain the certification.

In 2008, the ABU introduced a certification in pediatric urology for doctors who treat children 70 percent of the time. In 2013, the board introduced the subspecialty certification in female pelvic medicine and reconstructive surgery (FPM-RS) board-certified subspecialty of urologic oncology. Doctors who practice medicine in this area of expertise can receive additional training through fellowship programs, attending conferences and other training programs, and membership in organizations such as the Society of Urologic Oncology.

Services and procedures performed: Urologic oncologists are surgeons who specialize in the management and treatment of cancer. This includes evaluating, diagnosing, and treating cancer or suspected cancer in the prostate, bladder, kidney, and testicles. Conditions such as urinary retention and blood in the urine are also treated.

Typically, the doctor asks questions on the first visit to assess the problem. After the patient’s initial examination, a series of tests may be recommended to determine the type and extent of the disease. Some of these diagnostic tests may include a blood test, urine test, cystoscopy (insertion of a small scope to view the inside of the bladder and ureter), digital rectal exam, biopsy, cystourethrogram (an X-ray taken of the bladder and urethra while urinating), ultrasound, or other imaging studies.

Depending on the test results, the doctor devises a treatment plan, which may be aggressive to rid the body of disease or simply palliative to alleviate symptoms associated with the cancer. When the cancer is localized, meaning limited to an organ or specific area, aggressive treatment is often undertaken to get rid of the disease. When the cancer has spread to other areas of the body, called metastasis, treatment often involves minimizing symptoms and discomfort instead of trying to cure the body of the disease.

Some procedures performed by urologic oncologists include laparotomy (incision in the abdominal wall to view inside the abdomen), transurethral resection (to diagnose and remove cancer of the bladder or prostate), cystectomy (partial or complete removal of the bladder), and prostatectomy (partial or complete removal of the prostate gland). In addition to surgery, treatment may include the use of hormone therapy, radiation, chemotherapy, or combinations of these therapies. When other treatment options are considered, a urologic oncologist may include other team members specializing in treating these cancers.

Related specialties and subspecialties: Many urologic oncologists work with specialists in oncology fields such as radiation, chemotherapy, and immunotherapy. Pathologists are also intimately involved in the diagnostic process.

A pathologist is a doctor who specializes in identifying diseases by examining tissues and cells under a microscope to determine whether cancer cells are present and, if they are, how aggressive the disease is. The pathologist’s report is critical for treatment.

A radiation oncologist uses radiotherapy, which is high-energy waves or particles, to destroy or damage cancer cells. This is done using an electron beam, X-ray, radiation, or cobalt therapy. This type of treatment is primarily used to treat localized cancer, though it is also used for total body irradiation in preparation for a bone marrow transplant in some instances.

A medical oncologist specializes in using chemotherapy, hormone therapy, and biological therapy for the treatment of cancer. Chemotherapy is often used when the cancer has metastasized or spread throughout the body. This can be delivered intravenously, by injection, or with a pill. Hormone therapy, commonly used in the treatment of prostate cancer, involves administering hormones to suppress the production of testosterone in the body. This helps stop the production of cancer cells. Immunotherapy, sometimes called biological or biotherapy, uses treatments to stimulate the body’s immune system to fight disease. This can be done by administering a drug or by stimulating the body’s immune system to work harder to fight disease. This type of treatment is often used in conjunction with other therapies to enhance the effect.

When cancer is not contained within the urinary or male reproductive systems, assistance may be required from doctors who specialize in treating other areas of the body, such as gynecologists. It is common to have a treatment team consisting of specialists in urologic oncology, pathology, radiation therapy, chemotherapy, immunotherapy, and other areas working together to fight the disease.

Bibliography

Das, Hrishikesh, and Ronald Rodriguez. "Health Care Disparities in Urologic Oncology: A Systematic Review." Urology, vol. 136, 2020, pp. 9-18. doi.org/10.1016/j.urology.2019.09.058.

Grüne, Britta, et al. "Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review." European Urology Focus , vol. 8, no. 3, 2022, pp. 851-869. doi.org/10.1016/j.euf.2021.04.013.

Helmer, Jodi. "What Is a Urologic Oncologist?" WebMD, 16 May 2023, www.webmd.com/prostate-cancer/what-is-urologic-oncologist. Accessed 20 July 2024.

Hugar, Lee A., et al. "Incorporating Palliative Care Principles to Improve Patient Care and Quality of Life in Urologic Oncology." Nature Reviews Urology, vol. 18, no. 10, 2021, pp. 623-635. doi.org/10.1038/s41585-021-00491-z.

McAninch, Jack W., and Tom F. Lue. Smith & Tanagho's General Urology. 19th ed. McGraw, 2020.

Merseburger, Axel, and Maximilian Burger. Urologic Oncology. Springer International Publishing, 2020.

Merseburger, Axel S., Markus A. Kuczyk, and Judd W. Moul, eds. Urology at a Glance. Springer, 2014.