ENHANCED
MANAGEMENT

Uro-oncology – a leading-edge field for the
treatment of Prostate, Kidney, Bladder and Testicular Cancers

Uro-oncology is a specialised, cutting-edge branch of Urology which includes very common cancers like prostate, kidney and urinary bladder cancer. A rapid pace of research with new developments every day makes this a very exciting field.

Advances in Prostate Cancer
Prostate Cancer is the commonest Cancer among western men and is becoming very common in India as well. International health agencies recommend annual PSA screening in men aged 50-70 years to detect Prostate Cancer early, however, this resulted in the diagnosis of low-grade cancers which may not affect the patient’s life. With an understanding of this natural history, specific tests to detect aggressive cancers were developed. Utilising PSAderivatives and related molecules, newer tests like the 4-K Score (PSA, free-PSA, intact-PSA and HK-2) and the Prostate Health Index (PSA, f-PSA and -2-pro PSA) developed excellent accuracy for the detection of aggressive Prostate Cancer. These tests are used routinely abroad and are gradually being introduced in India. Multiparametric MRI of the prostate has revolutionised prostate imaging with excellent accuracy for aggressive Prostate Cancer. Using MRI to guide biopsies can reduce the detection of harmless cancers by 30% and increase the detection of aggressive cancers by 15%.

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Advances in Kidney Cancer
Partial Nephrectomy (PN) to conserve renal function has been the gold standard for renal masses <4cm. Recent studies have shown the oncologic safety of this

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"Uro-oncology is devoted to the diagnosis and treatments of tumours of urinary systems. Most importantly, taking care of patients with prostate cancer, kidney, testicular and bladder cancer." 1

approach even for tumours up-to 7cm and recent guidelines recommend whenever possible. This is crucial given the rampant nature of Diabetes and Hypertension in India, diseases which can also affect renal function. With the robotic platform, surgeons have a truly minimally-invasive alternative to tackle complex tumours with reduced bleeding, quicker recovery and comparable ischemia times to open surgery. Medications targeting vascular growth factors have truly changed the management of metastatic disease allowing prolonged responses in many patients and sometimes making unresectable Tumours operable.

Advances in Bladder Cancer
Radical Cystectomy for Invasive Bladder Cancer remains a complicated procedure. The RAZOR trial was published in The Lancet in June 2018 which showed that Robotic Cystectomy has comparable Oncologic outcomes, less bleeding and shorter hospital stay than Open Cystectomy. It was the world’s first multicenter randomised trial comparing robotic to open surgery for any organ site. Refinements in the technique now allow us to perform urinary diversions intracorporeally with the robot – a truly minimally-invasive approach.

Dr. Vivek Venka

Dr. Vivek Venkat
Consultant
Uro-oncologist &
Robotic Urologist
Nanavati Super
Speciality Hospital
Mumbai

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