Expert Q & A: Diagnosis without delay
Mr Pardeep Kumar, Consultant Urological Surgeon, explains the diagnostic process for urological cancers at The Royal Marsden.
What are the signs and symptoms of urological cancers?
Urinary tract symptoms that should prompt rapid referral include blood in the urine, pain in the loin, atypical urinary symptoms or a new palpable lump within the scrotum.
Symptoms of urinary tract cancers are non-specific, so any patient presenting with the above symptoms requires investigation to rule them out. Blood in the urine is often the presenting sign in bladder cancer, and may also lead to the diagnosis of kidney or prostate cancer.
Difficulty passing urine or symptoms of urinary tract infection that do not respond to antibiotics also require investigation. The typical presentation for testicular cancer is a young man who has felt a new lump in the scrotum.
How are they diagnosed at The Royal Marsden?
Patients referred for rapid diagnosis come to the Rapid Diagnostic and Assessment Centre (RDAC) in the morning and undergo urine and blood tests, along with imaging that is appropriate to the case. This will depend on the patient, but could include ultrasound, CT or MRI scans.
In men who are suspected of having prostate cancer, careful counselling takes place prior to commencing the diagnostic pathway. This may include repeat urine testing and a PSA blood test. Appropriate patients may proceed to a prostate biopsy on the same day. A targeted prostate biopsy using the latest techniques is possible by carrying out MRI scanning and incorporating the information into biopsy technology that is unique to The Royal Marsden in the UK.
What techniques or equipment are used?
The Royal Marsden’s RDAC has the latest diagnostic equipment available. Our MRI scanners produce the highest-resolution images available commercially. In prostate cancer diagnosis, we use a method of combining MRI scans with real-time ultrasound to target lesions within the prostate – a unique system in the UK.