Urological oncology: what has changed in the recent 25 years?

Abstract

A considerable progress in the diagnosis and treatment of urinary tract cancers in the last 25 years is observed. A short review of this process is presented, together with the epidemiological data on most frequent cancer locations. Multiparametric magnetic resonance allows for an improved detection of small prostate cancers and more precise resection; this may be combined with ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging. Prostate cancer gene 3 (PCA3) is a new prostate cancer cell-specific marker. A “watchful waiting” method of deferred treatment is now substituted by “active surveillance”. 3-Dimensional Conformal Radiation Therapy, Intensity Modulated Radiation Therapy, Image-Guided Radiation Therapy and other techniques facilitate more precise and dose-increased prostate cancer irradiation. Despite the implementation of new techniques in bladder cancer detection, like photodynamic diagnosis and narrow band imaging, overall treatment results remain poor. Due to the progress of imaging techniques c. 50% of new renal cancer cases are now randomly detected and may be treated by nephron sparing surgery. The population of young men, cured definitely from testicular cancer, due to the excellent overall treatment results, is increasing; this requires more attention attributed to their social (i.e. reproductive) problems.