What Are The Risk Factors For Bladder Cancer In Males
Several factors have been linked with an increased risk of developing bladder cancer, both in men and in women. Some of these include:
- Age: Bladder cancer predominantly affects older adults. In the United States, over 90% of people diagnosed with bladder cancer are 55 years and older.
- Race/Ethnicity: Bladder cancer risk varies by race and ethnicity, the causes of which remain unclear. In the United States, White men are approximately twice as likely to develop bladder cancer compared with men of other races. Similarly, the risk in non-Hispanic men is around double that of Hispanic men.
Treatment For Bladder Cancer
Treatment for bladder cancer depends on how quickly the cancer is growing. Treatment is different for non-muscle invasive bladder cancer and muscle-invasive bladder cancer.
You might feel confused or unsure about your treatment options and decisions. Its okay to ask your treatment team to explain the information to you more than once. Its often okay to take some time to think about your decisions.
When deciding on treatment for bladder cancer, you may want to discuss your options with a urologist, radiation oncologist and medical oncologist. Ask your GP for referrals.
Bladder Cancer By Ethnicity
White people are more likely to develop bladder cancer than Black or Hispanic people.
White men have double the risk compared to Black men. However, research has suggested that Black people with bladder cancer may have a worse prognosis. Experts are still trying to understand the different factors contributing to this disparity.
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Extent Of Cancer At The Time Of Diagnosis
About half of all bladder cancers are first found while the cancer is still found only in the inner layer of the bladder wall. About 1 in 3 bladder cancers have spread into deeper layers but are still only in the bladder. In most of the remaining cases, the cancer has spread to nearby tissues or lymph nodes outside the bladder. Rarely , it has spread to distant parts of the body. Black patients are slightly more likely to have more advanced disease when they’re diagnosed, compared to whites.
Treating Stage Iii Bladder Cancer
These cancers have reached the outside of the bladder and might have grown into nearby tissues or organs and/or lymph nodes . They have not spread to distant parts of the body.
Transurethral resection is often done first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy is then the standard treatment.Partial cystectomy is rarely an option for stage III cancers.
Chemotherapy before surgery can shrink the tumor, which may make surgery easier. Chemo can also kill any cancer cells that could already have spread to other areas of the body and help people live longer. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemo is given first, surgery to remove the bladder is delayed. The delay is not a problem if the chemo shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with radiation is possible instead of surgery.
Some patients get chemo after surgery to kill any cancer cells left after surgery that are too small to see. Chemo given after cystectomy may help patients stay cancer-free longer, but so far its not clear if it helps them live longer. If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.
Bladder Cancer Treatment In Men Vs Women
As with most cancers, there are more treatment options for bladder cancer when it is detected early. Most people require a combination of therapies to treat bladder cancer successfully.
At MSK, we have the benefit of a multidisciplinary team of experts who are highly specialized in urology, radiation oncology, medical oncology, radiology, and pathology, Dr. Feld says. We all work very closely together to deliver the highest quality care to our patients.
For men and women with disease that is more advanced but still confined to the bladder, a common treatment is removal of the bladder in a surgical procedure known as a radical cystectomy. The urologic surgeon will likely also remove lymph nodes and/or some of the organs near the bladder. This may include the prostate in men and the uterus and ovaries in women.
Its important to know that expert bladder cancer care means not only lifesaving treatments but also preserving quality of life. A recent study showed that people who had their bladder removed at MSK recover well from the surgery and have a good quality of life.
Screening And Early Detection
Currently, no professional organizations recommend routine screening for bladder cancer. Thats because available tests arent always reliable and havent reduced the risk of dying from bladder cancer in people who dont have an elevated risk. However, some healthcare providers may recommend tests for people with a high risk of bladder cancer.
Some of the tests may include:
- Urinalysis: Checks for blood and other substances in the urine
- Urine cytology: A microscope search for cancer cells in urine
- Tumor marker urine tests: Looks for substances in urine that could signal bladder cancer
These tests may detect some cases of bladder cancer early, but theyve been known to miss some or provide false-positive results.
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What Are The Symptoms Of Bladder Cancer
The most common symptom of bladder cancer is visible blood in the urine.1 Other common symptoms are frequent, urgent, or painful urination. These symptoms are not always caused by bladder cancer, but it is important to speak with your healthcare provider if you experience them. Treatment is typically more effective for bladder cancer when its in its earliest stages.
Bladder Cancer: Men At Risk
Genitourinary malignancies are a worry for men. In adolescents and young adults, testicular cancer is the main concern. One of the unappreciated benefits of growing older is that cancer of the testicles becomes rare but as men outgrow that risk, they face the problem of prostate cancer. With these well-publicized diseases to head their worry list, it’s easy for men to overlook bladder cancer but that would be a mistake. In fact, about 53,000 American men will be diagnosed with the disease this year alone, and over 10,000 will die from it.
Bladder cancer is the fourth most common internal malignancy in American men it is also one of the 10 deadliest cancers, and it saps our strapped economy of almost $3 billion a year. But there’s good news, too. Early diagnosis can nip the disease in the bud, and new treatments are improving the outlook for patients with advanced disease. And when it comes to good news, you’ll also be glad to know that you can take simple steps to reduce your risk of getting bladder cancer.
When To Contact A Doctor
Its important to be proactive if you have early signs and symptoms of this disease. An early diagnosis can greatly improve your outlook.
Because bladder cancer is less common in women than men, a healthcare professional may take a conservative approach. In many instances, bladder cancer symptoms in women do turn out to be other conditions. Still, you may prefer to be cautious.
If youre not comfortable with the advice you get from a clinician, consider getting a second opinion. This may be especially important if you have risk factors for bladder cancer.
What To Do Before And After Treatment
Talk with your doctors about whether you need to do anything to prepare for treatment and help your recovery. Some things they may suggest are to:
- Stop smoking if you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment and you may have more treatment-related side effects. Continuing to smoke also increases your risk of cancer returning.
- Begin or continue an exercise program exercise will help build up your strength for treatment and recovery. It can also help you deal with side effects of treatment.
- Improve diet aim to eat a balanced diet with a variety of fruit, vegetables, wholegrains and protein. Eating well can improve your strength and you may respond better to treatment.
- See a physiotherapist they can teach you exercises to strengthen your pelvic floor muscles, which help control how your bladder and bowel work. These exercises are useful if you have a neobladder, a partial cystectomy, or radiation therapy.
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Treatment For Advanced Bladder Cancer
If bladder cancer has spread to other parts of the body, it is known as advanced or metastatic bladder cancer. You may be offered one or a combination of the following treatments to help control the cancer and ease symptoms:
- systemic chemotherapy
- radiation therapy.
Immunotherapy uses the bodys own immune system to fight cancer. BCG is a type of immunotherapy treatment that has been used for many years to treat non-muscle-invasive bladder cancer.
A new group of immunotherapy drugs called checkpoint inhibitors work by helping the immune system to recognise and attack the cancer. A checkpoint immunotherapy drug called pembrolizumab is now available in Australia for some people with urothelial cancer that has spread beyond the bladder. The drug is given directly into a vein through a drip, and the treatment may be repeated every 2 to 4 weeks for up to 2 years.
Other types of checkpoint immunotherapy drugs may become available soon.
Types Of Bladder Cancer
Once diagnosed, bladder cancer can be classified by how far it has spread.
If the cancerous cells are contained inside the lining of the bladder, doctors describe it as non-muscle-invasive bladder cancer . This is the most common type of bladder cancer.
When the cancerous cells spread beyond the lining, into the surrounding bladder muscle, it’s referred to as muscle-invasive bladder cancer . This is less common, but has a higher chance of spreading to other parts of the body.
If bladder cancer has spread to other parts of the body, it’s known as advanced or metastatic bladder cancer.
Read more about diagnosing bladder cancer.
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Side Effects Of Treatment For Bladder Cancer
All cancer treatments can have side effects. Your treatment team will discuss these with you before you start treatment. Talk to your doctor or nurse about any side effects you are experiencing. Some side effects can be upsetting and difficult, but there is help if you need it.
or email to speak with a caring cancer nurse for support.
Always See A Doctor If You Notice Blood In Your Urine
Anyone who sees blood in their urine should notify a doctor or urologist immediately. Doctors typically investigate hematuria first with a urinalysis and urine culture. In women, tests can also distinguish if the bleeding is due to postmenopausal uterine bleeding. If there is no evidence of infection or postmenopausal bleeding, the next step is a CT scan that focuses on the entire urinary tract, known as a CT urogram.
Blood in the urine can come from either the bladder or upper urinary tract , and a CT urogram will evaluate the entire urinary system, Dr. Feld says.
Along with a CT urogram, doctors may perform a cystoscopy. This is a direct visualization of the bladder with a lighted camera, called a cystoscope. Usually done in the office, it takes only a few minutes and does not require anesthesia. In addition, doctors can order a test called a urine cytology to check for cancer cells in the urine.
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How Common Is Bladder Cancer
The American Cancer Societys estimates for bladder cancer in the United States for 2022 are:
- About 81,180 new cases of bladder cancer
- About 17,100 deaths from bladder cancer
The rates of new bladder cancers and deaths linked to bladder cancer and have been dropping slightly in women in recent years. In men, incidence rates have been decreasing, but death rates have been stable.
Bladder cancer is the fourth most common cancer in men, but it’s less common in women.
Why Is There A Disparity Between Men And Women With Bladder Cancer
In many cases, there are significant delays in diagnosing bladder cancer in women. Many women ignore the most basic symptomblood in the urine. They may associate it with menstruation or menopause and delay reporting this symptom to their doctors. Even after reporting the problem to their doctors, blood in the urine may be initially misdiagnosed. It may be seen as a symptom of post-menopausal bleeding, simple cystitis or a urinary tract infection. As a result, a bladder cancer diagnosis can be overlooked for a year or more.
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How Does Bladder Cancer Spread
Bladder cancer usually begins in the cells of the bladder lining. In some cases, it may spread into surrounding bladder muscle. If the cancer penetrates this muscle, it can spread to other parts of the body, usually through the lymphatic system.
If bladder cancer spreads to other parts of the body, such as other organs, it’s known as metastatic bladder cancer.
Pain In Other Areas Of Your Body
Advanced bladder cancer may spread to these areas of the body:
As cancer metastasizes, it may infiltrate bones throughout your body. This can result in bone pain or tenderness at night or during activity. Your bones may also be more susceptible to breakage.
Cancer that has spread to your lungs may cause chest pain. It may also make it hard for you to breathe, cause a chronic cough, or cause your voice to sound different.
Cancer that has spread to your abdomen or liver may cause stomach pain.
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Transurethral Resection Of A Bladder Tumour
If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and tested for cancer .
TURBT is carried out under general anaesthetic.
Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread, but this may be a separate operation within 6 weeks of the first biopsy.
You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning if the removed cells are found to be cancerous.
See treating bladder cancer for more information about the TURBT procedure
Why Is Bladder Cancer More Common In Males Than Females
The reasons for the large difference in bladder cancer rate between men and women are not fully understood. Several factors may play a role, both environmental and biological.
- Environmental: As previously mentioned, a higher rate of tobacco smoking in men is thought to be a major contributor to their higher risk of bladder cancer.5 Men are also traditionally more likely to be employed in occupations associated with the production of paint, metal, petroleum products, and rubber, where they may be exposed to known carcinogens. Dietary factors may also play a part for example, males may have a tendency for greater consumption of processed meats, which has been linked to a higher risk of bladder cancer in several studies.
- Biological: After allowing for environmental factors such as smoking and occupational exposures, there is still a higher rate of bladder cancer in men compared with women.6 Recent research suggests that an X chromosome-linked gene may be significant. Associated with suppression of the tumor, this gene is more highly expressed in females compared with males . Differences between males and females in sex hormones and sex hormone receptors have also been implicated.6,7
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What Can You Do
The most important thing for you is to know the signs and symptoms of bladder cancer. Be sure to report them to your physician immediately. The most common signblood in the urinecan be visible but could also only be detected under a microscopic examination. It is important to visit your doctor for routine examinations. Most bleeding associated with bladder cancer is painless. Close to 30 percent of bladder cancer patients experience burning, frequent urination or a sensation of incomplete emptying when they urinate.
If you experience any of these symptoms, see your doctor as soon as possible. Many women may first go to a primary care physician or gynecologist if they have blood in their urine. Primary care and gynecology follow their own guidelines for assessing blood in urine. This can sometimes delay their diagnosis until the cancer is more advanced. A urologist is generally the medical professional that diagnoses bladder cancer. View the American Urological Association Guidelines for Microhematuria. Blood in urine is not normal and should be checked out.
Why Women With Bladder Cancer Fare Worse
Some cancerssuch as pancreatic cancercan be difficult to detect because they cause few if any noticeable health effects. Thats seldom the case for bladder cancers, which often cause hard-to-miss symptoms. Typically, patients see blood in their urine and that leads them to come in for evaluation, says Dr. Yair Lotan, a urologist at the University of Texas Southwestern Medical Center in Dallas.
UTI misdiagnoses may partly explain why women with bladder cancer tend to experience worse outcomes than men. But theyre not the whole story. Research has found that after first noticing blood in their urine, women with bladder cancer go an average of 85 days before receiving a proper diagnosis. For men, the average wait is 74 days. Statistically speaking, that difference is significant. But its not large enough to fully explain the sex disparities in disease outcomes. Biology also seems to play a part. Theres been some work on hormonal factors, Lotan says. Specifically, some work has found that estrogen receptors in the lining of the bladder might play a role in the formation of cancer cells. Researchers have also found that male sex hormones also seem to affect the development of bladder cancer cells. Its possible that these sex-dependent biological characteristics change the activity of bladder cancers in ways that help account for the different incidence rates and outcomes.
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