8.13 Bladder and Prostate Cancer
This section will provide an overview of two common cancers affecting the urinary tract – bladder cancer and prostate cancer.
Bladder Cancer
Bladder cancer is the most common malignancy affecting the urinary system. Bladder cancer is classified as non-muscle invasive, muscle-invasive, or metastatic, with treatment and prognosis based on the severity of the disease.[1]
Signs and Symptoms
Clients with bladder cancer typically have hematuria and some may have frequency, urgency, dysuria, and nocturia.[2]
Diagnostic Testing
The presence of hematuria requires diagnostic testing that usually begins with cystoscopy and biopsy of suspicious tissue or tumors. Read more about cystoscopy in the “General Urinary System Assessment” section of this chapter.
If tumors are found on cystoscopy, a transurethral resection of bladder tumor (TURBT) is typically performed to remove the tumor(s) and stage the cancer. If bladder cancer is diagnosed, additional diagnostic testing for staging the cancer includes CT, MRI, and PET scans.[3]
Medical Treatment
Treatment is based on biopsy results that indicate if the cancer has invaded the bladder muscle tissue. For clients with bladder cancer that has not invaded the bladder muscle tissue, conservative treatment typically includes removal of the tumor with a TURBT followed by chemotherapy administered directly into the bladder, referred to as intravesical therapy. This conservative treatment is used to maintain a functional bladder.[4]
Muscle-invasive bladder cancer is treated with radical cystectomy, meaning removal of the bladder and regional lymph nodes. In males, radical cystectomy also includes the removal of the prostate and seminal vesicles. When a client’s bladder is removed, urinary flow must be redirected, referred to as urinary diversion. Three common types of urinary diversion include the following[5]:
- Ileal conduit: A diversion is created for the urine to flow from the ureters through a segment of bowel (usually the ileum) to a stoma on the skin surface, where it is collected using an external appliance.
- Cutaneous continent reservoir: A reservoir is constructed under the skin and the client self-catheterizes at regular intervals to empty the reservoir. This option avoids the need for an external appliance.
- Orthotopic neobladder: A neobladder is formed from a segment of the bowel and attached to the urethra, enabling the client to void through the urethra.
If a client is diagnosed with metastatic cancer, they are typically treated with chemotherapy, immunotherapy, or targeted therapies.
Chemotherapy
Chemotherapy uses medications to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body.[6]
Targeted Therapy
Targeted therapy uses medications or other substances to identify and attack speci