Overview

Our cutting-edge Cancer Therapy Center offers the latest treatments and procedures for all types of urologic cancers. Whether you are concerned about cancer or have a diagnosis already, our highly skilled physicians are ready to present you with a variety of options. We are here for you through every step of the way. Urologic cancers we treat include Prostate Cancer, Bladder Cancer, Kidney Cancer, Penile Cancer, Ureteral Cancer, Urethral Cancer, Adrenal Cancer and Testicular Cancer. Our team delivers the most advanced oncologic care in the most compassionate way.

One of our cancer specialists, Dr A. Dev Mally, was a Fellow and Clinical Instructor in the Department of Surgery at Memorial Sloan Kettering Cancer Center. This hospital has ranked as one of the top two hospitals in cancer care every year since U.S. News & World Report began its annual “America’s Best Hospitals” survey in 1990. This Cancer Center is regarded as the most prestigious hospital in the world for treating urologic cancers, and the field of Urologic Oncology was created at this institution. Our surgeons are well trained in da Vinci® robot-assisted procedures, endoscopy, laparoscopy and open surgery. Your treatment will be personalized to your specific disease. Schedule a consultation today.

Bladder Cancer

Bladder cancer is the fourth most common cancer in men and the eighth most common cancer in women. It typically occurs in men over the age of 55. Most bladder cancers are diagnosed early and are treatable. The most common type is urothelial carcinoma (UC).  It starts with mutation of the cells in the lining of the bladder. Other rare types include squamous cell carcinoma and adenocarcinoma. The first warning signs may be blood in the urine (hematuria), painful urination, frequent urination, and pelvic pain. Smoking is attributed to 50% of bladder cancers. Other risk factors include workplace chemicals, family history, and cancer treatments such as chemotherapy and radiation therapy.

Bladder cancer is diagnosed by the following tests:

  • Urinalysis: This test checks for cancerous cells.
  • Cystoscopy: This test evaluates the bladder for any abnormalities. A small scope called a cystoscope is inserted into the urethra to evaluate your urethra and bladder lining. It is used to visualize the bladder neck and bladder. This will allow us to determine any abnormal findings to include stones, masses, tumors, cancer, and foreign bodies.
  • Biopsy: A sample of bladder tissue is taken during the cystoscopy.
  • Imaging: This is usually a CT scan to allow us to see the entire urinary tract and surrounding tissues.

If a diagnosis of bladder cancer is confirmed, additional specialized tests may be ordered such as a MRI, Bone Scan, and Chest X-Ray. Additionally, a pathologist will grade the bladder tissues samples to help determine treatment options. The higher the grade, the more likely it will grow fast and spread. Grades or Stages include:

  • Stage Zero: The cancer cells are only on the inner lining of the bladder.
  • Stage 1: The tumor has grown deeper into the bladder inner lining but has not invaded the bladder muscle. Most bladder cancers are Stage 1.
  • Stage 2: The tumor has invaded the bladder muscle, but is still confined to the bladder.
  • Stage 3: The tumor has spread through the muscles of the bladder to invade surrounding tissue.
  • Stage 4: The tumor has spread to the lymph nodes and other parts of the body.

Treatment choice is determined by the stage and grade of the tumor, where it is located, whether it has spread, and your general health and age. Options include Surgery, Chemotherapy, Radiation therapy, or a combination of those. Your urologist will help you make the most informed decision.

  • TURBT (transurethral resection of bladder tumor): This surgery is often used in early stage bladder cancers. Your urologist will pass an electrosurgical loop through a cystoscope and into your bladder. The loop removes all visible tumor and it also allows us to collect tissue for the pathologist. Painful or bloody urination are the most common adverse events.
  • Radical Cystectomy: This surgery is usually performed robotically to remove the entire bladder. It is reserved for invasive bladder cancer or when other therapies have not been successful. Surrounding lymph nodes and sexual organs are also removed. Risks include erectile dysfunction, infertility, and premature menopause for women.
    • Urinary Diversion: This is a procedure necessary for patients who receive a radical cystectomy. The body now needs a new way to store and expel urine in the absence of your bladder.
    • Urinary Conduit: This is the most common type of diversion where a segment of the intestine is used to create a pipe connecting the ureters to the outside of the body through an opening in the abdominal wall. Your urine empties into a pouch (urostomy bag) that you wear on your abdomen. This is the simplest procedure although some patients do not like the external appearance.
    • Cutaneous continent urinary diversion: An internal pouch is created from the intestines and urine is diverted here. Urine is drained from the pouch through a hole in your abdomen via a catheter a few times a day. There is a one way valve to keep the urine inside the pouch.
    • Neobladder (new bladder): A segment of the intestine is harvested and used to create a new bladder. This procedure allows you to urinate in a more normal fashion. The biggest disadvantage is incontinence. The surgery is also more complex and patients have to re-learn how to urinate. You may also need to use a catheter to drain all the urine from the neobladder.
  • Chemotherapy: This is an important treatment for advanced bladder cancer. It usually involves two or more drugs to kill cancer cells. Drugs are injected into a vein in your arm (inatravenously). It may be administered before and/or after surgery.
  • Radiation Therapy: This can be used after surgery to kill any remaining cancer cells. It is sometimes combined with chemotherapy in patients with invasive bladder cancer. High energy beams are delivered from a machine aimed to destroy your cancer at precise points.

Kidney Cancer

Kidneys are two bean shaped organs that filter and clean the blood. Waste is removed by the creation of urine. The most common kidney cancer, Renal cell carcinoma (RCC), forms in the lining of the tubes that filter the blood inside the kidneys. Over 90% of kidney cancers are RCC. Kidney cancer is among the top ten most common cancers in both men and women, with men having twice the risk. Most cases occur between the ages of 50-70. With early diagnosis, the survival rate is excellent.

Risk factors that can increase your chance of kidney cancer include:

  • Smoking
  • Family history
  • Obesity
  • Race – African Americans and Native Americans have a slightly higher risk
  • Sex – Men have about twice the risk
  • High blood pressure
  • Exposure to workplace chemicals
  • Long-term dialysis
  • Genetic disorders such as von Hippel-Lindau disease

Symptoms of kidney cancer include:

  • Blood in the urine (hematuria)
  • Lump in the abdomen or side
  • Weight loss without trying
  • Pain in your side, flank, or lower back that won’t go away
  • Fatigue
  • Fever
  • Swelling in your ankles or legs
  • Anemia

The diagnosis of kidney cancer will include a complete medical history and physical exam. You will receive a urinalysis, blood tests, and imaging. Often kidney cancer is discovered by accident during the diagnosis of other conditions. In some situations a biopsy may be recommended, but most often surgery is performed and then the tumor is examined by a pathologist. Staging the tumor will show the extent of the disease and determine next steps.

  • Stage 1: The tumor is small and confined to the kidney (7cm or smaller).
  • Stage 2: The tumor is confined to the kidney but larger (7cm+).
  • Stage 3: The cancer has spread to lymph nodes or blood vessels.
  • Stage 4: The cancer has invaded other organs such as the lungs, liver, and bones.

Treatment options include surgery, targeted therapy, and chemotherapy to kill any remaining cancer cells. In most cases, tumor removal is the first step. The type of surgery depends on the size and stage of the tumor.

Types of treatments include:

  • Radical nephrectomy is the removal of the whole kidney and is performed by one of our robotically trained urologists using the da Vinci® Robotic system.
  • Partial nephrectomy is removal of only the part of the kidney that contains the tumor. This is also done robotically and may be appropriate for early stage disease.
  • Cryosurgery is a procedure to freeze and kill the tumor.
  • Radiofrequency ablation is a procedure to destroy the tumor with heat.
  • Active surveillance involves delaying treatment and monitoring the tumor.
  • Chemotherapy is utilized in more advanced cases.

Advanced Urology will develop a customized treatment plan that will provide the most cutting-edge therapy with the best possible outcome. Many of our urologists have advanced robotic training which provides you with a less-invasive surgery resulting in quicker recovery and fewer complications. Your treatment will be determined by your age, health, size, and location of your tumor. We are here for you.

Penile Cancer

Penile cancer is a rare form of cancer occurring in less than 1% of men in the US. Over 95% of penile cancers are from squamous cells found in the foreskin. They grow slowly and are usually found in the form of a small lesion. It is typically seen in uncircumcised men between the ages of 50-70. Some risk factors include smoking and sexually transmitted diseases such as herpes simplex virus and Human papillomavirus (HPV). HPV 16, 18, and 31 are seen in over 50% of cases.

Common symptoms of penile cancer include:

  • Change in skin of the penis such as color, thickness, ulcers, or lumps.
  • Swelling of the penis.
  • Open sore that won’t heal.
  • Foul smelling discharge.
  • Swollen lymph nodes in the groin.

Diagnosing penile cancer will usually include a physical exam and biopsy. If the pathologist finds the cells are cancerous, additional tests are ordered. These may include ultrasounds, CT, MRI, and PET scans. The imaging determines the stage of the cancer and the course of action for treatment.

Stages include:

  • Stage 1: The cancer is in tissue just under the skin of the penis.
  • Stage 2: The cancer has spread to erectile tissue or one lymph node.
  • Stage 3: The cancer has spread to more than one lymph node and may have also invaded the prostate or urethra.
  • Stage 4: The cancer has spread to several lymph nodes and to other organs in the body.

Surgery is the most common treatment for penile cancers. Treatments include:

  • Topical chemotherapy may be an option for pre-cancerous lesions.
  • Circumcision removes the cancer when it is only in the foreskin.
  • Laser surgery is appropriate for squamous cell cancer that is only in the outer layer of skin. It is destroyed with a beam of light.
  • Mohs surgery removes the cancer in thin layers. The tissue is examined under a microscope and the procedure continues until no cancer is seen. It is a slow process, but saves as much of the healthy tissue as possible.
  • Cryosurgery freezes and destroys the cancer cells.
  • Partial penectomy removes the tumor and part of the penis.
  • Total penectomy removes the entire penis.
  • Lymph node surgery is require for stage 2 or higher.
  • Radiation therapy is used in early stage penile cancer to avoid surgery, and it is also used following surgery in more advanced cases on the lymph nodes.
  • Chemotherapy is used for cancers that have spread to the lymph nodes or other organs.

Advanced Urology offers state-of-the-art solutions for penile cancer. Please remember it is crucial to detect it early, so do not feel embarrassed about discussing symptoms with your doctor. If caught early and removed, it is very treatable with little damage to the penis. We are here for you every step of the way.

Prostate Cancer

Prostate cancer is the #1 most common cancer among men aside from non-melanoma skin cancer. Every year more than 248,900 American men are diagnosed with prostate cancer, and 33,720 die from the disease, according to the National Cancer Institute.  In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free. Because approximately 90% of all prostate cancers are detected in the early stages, the cure rate for prostate cancer is very high-nearly 100% of men diagnosed at this stage will be disease-free after five years. It’s important to know the facts about prostate cancer so you and your family can make informed choices about screening and treatment.

Scientists are still trying to determine what causes prostate cancer. What they do know is that there are probably many reasons the disease occurs-and that by examining common risk factors, they can better determine who is likeliest to develop it. These risk factors include:

  • Age: The diagnosis of prostate cancer is rare in men younger than 40. As men age, they are increasingly more likely to develop it. 1 in 6 men will be diagnosed in their lifetimes.
  • Family history: If your father, grandfather, brother, son or other closely related family member has had prostate cancer, you are at an increased risk yourself.
  • Race: African-American men are 60% more likely to develop prostate cancer than Caucasian or Hispanic men. The disease is rarer among Asian-American and American Indian men.
  • Diet: Some studies suggest that men with diets high in fat may be at higher risk. Other research suggests that nutritional factors, like greater intake of vitamin D, lycopene and selenium, may lower a man’s risk of developing prostate cancer.

What are the symptoms of prostate cancer?

It’s important to understand that by the time prostate cancer symptoms usually appear, the cancer is likely in a later stage and is generally not curable. The disease needs to be found and cured before symptoms develop, which is why prostate cancer screenings are recommended starting at age 40.

Men with early-stage prostate cancer may not have symptoms at all. In fact, it could be 10 years before symptoms become noticeable. Some older men may never even know that they have prostate cancer since it may have not progressed or caused symptoms in their lifetime. And other forms of the disease may be small and grow so slowly that they don’t require treatment at all.

Some symptoms of prostate cancer may include:

  • Difficulty urinating and/or difficulty starting and stopping urine flow
  • Needing to urinate frequently, especially at night
  • Pain or burning during urination
  • Dull lower pelvic pain
  • Blood in the urine or semen
  • Painful ejaculation
  • Pain in the lower back, hips or thighs

Prostate Cancer Treatments:

Prostate cancer treatment depends on the age and health of the patient, the aggressiveness of the cancer and the extent of the cancer at the time of diagnosis. There is no data that shows one treatment is better than the others. However, all treatments for prostate cancer except observation may have an effect on the quality of life with urinary control, erectile function and bowel function being the primary concerns. For this reason, it is important to have a thorough discussion with your urologist to weigh the risks and benefits of each option.

Active Surveillance: This is also known as watchful waiting.  The timing of check-ups will vary for each man. It may be a personal choice or a choice because a man has a shorter life expectancy and wants to avoid possible problems with treatment. This may also be a good choice for a man with a longer life expectancy and a low-risk tumor. Other treatments can be initiated if the cancer shows signs of growth or of becoming more aggressive.

Radiation therapy: There are two types: interstitial prostate brachytherapy and external beam radiation therapy. If the cancer is very aggressive or more extensive, a combination of surgery followed by radiation therapy may be the best chance for a cure. With interstitial prostate brachytherapy, small radioactive “seeds” are planted in the prostate. Before treatment, the size of the prostate is checked to determine the dosage of seeds. These seeds are then placed into the prostate using needles that go through the skin between the scrotum and anus. With external beam radiation therapy, the prostate and other important tissues are treated with a carefully targeted beam of radiation. The advantage of radiation therapy is that it is less invasive than surgery. Urinary incontinence and erectile dysfunction may happen less often with radiation than with radical prostatectomy. However, one disadvantage of radiation therapy is that it leaves the prostate in the body. It is possible for some cancer to remain and worsen in the future.

Surgery: A radical prostatectomy is performed to remove the entire prostate. We have fellowship trained robotic surgeons who can expertly remove the prostate robotically.  This newer technology reduces the side effects and offers excellent cancer control.  Radical prostatectomy offers the man with cancer that has not spread outside the prostate the possibility of freedom from the disease for the rest of his life. The problems reported most often are erectile dysfunction and urinary incontinence. The chance of having erectile dysfunction depends on a man’s age and health, his sexual function before treatment, the stage of the cancer, and the ability to save the nerves that control erection during the surgery. Younger men (those under 60 years of age) are less likely to have problems with their erections than are older men. Even if erectile dysfunction does occur after surgery, erections may return to normal over time. Refer to Penile Rehabilitation under Erectile Dysfunction on our website for more information. While many men experience some form of urinary incontinence following prostate cancer treatment, the good news is, 90 to 95% of men do regain their continence with time without the need for additional surgery.

Hormone therapy: This involves stopping your body from producing the male sex hormone testosterone which stimulates the growth of prostate cancer cells. Another type of this therapy can block testosterone from getting into the cancer cells. Sometimes a combination of two drugs is used to achieve both effects. While hormonal therapy may lessen the cancer symptoms in men who choose not to or who cannot be treated with other therapies, it makes heart disease and diabetes worse in those who have these diseases.  It can be a useful treatment, but does have some undesirable side effects.  These include breast enlargement, reduced sex drive, erectile dysfunction, hot flashes, weight gain, and reduction in muscle mass.

Testicular Cancer

Testicular cancer is very rare. However, it is the most common cancer in men between the ages of 15 to 35. If detected early, it is curable in the majority of cases. Although the cause is unknown, the following risk factors have been found to be associated with the disease:

  • Undescended testicle
  • Family history of testicular cancer
  • Genetic condition known as Klinefelter’s Syndrome
  • HIV

Most testicular cancer is found during a self-exam or at a physical with your doctor. It is recommended that you do regular self-exams so that you will immediately notice any changes with your body. Symptoms may include:

  • Firm lump in your scrotum
  • Swelling or enlarged testicle
  • Fluid build-up in the scrotum
  • Pain or soreness in the testicle

If you or your doctor find a suspicious lump, blood tests are performed to identify tumor markers. Ultrasound, CT scan, chest x-ray, and MRI may be ordered as well. A lymph node dissection may also be performed to determine if the cancer has spread to the lymph nodes. If a diagnosis is confirmed, it is important to stage the cancer in order to develop the best treatment plan.

  • Stage 1: The cancer is confined within the testicle.
  • Stage 2: The cancer has spread to abdominal lymph nodes.
  • Stage 3: The cancer has spread to other lymph nodes or organs such as the liver and lungs.

Treatment for testicular cancer is determined by the stage. If you have Stage 1 cancer, outpatient surgery to remove the testicle is the gold standard of treatment. This usually cures the cancer. A schedule of follow-up appointments will be set to make sure the cancer has not returned. And, an artificial testicle can be implanted if you are concerned about appearance.

If you have Stage 2 or 3, you will need surgery to remove both the testicle and the lymph nodes. Chemotherapy or radiation may be needed for more advanced stages of the disease as well. We will walk you through the best treatment options for you.

It is important to consider your fertility during this process. You may wish to store your sperm in a sperm bank for the future. The majority of cancer is found in only testicle, so the other one will work fine to produce sex hormones and sperm. However, more advanced treatments such as chemotherapy and radiation can cause permanent infertility. One of our fellowship trained urologists, Dr. Tariq Hakky, is highly trained and experienced in preserving fertility. He will harvest sperm via a procedure called Onco-TESE to be stored in a local sperm bank.

Advanced Urology: The Premier Urology Group in the Southeast

Our mission is to better the lives of those we touch.  Our foundation is exceptional service, personalized care, and cutting edge treatments.  We work hard to continuously improve our accessibility, service, and quality.  We strive to build lifelong relationships with our patients and referring providers.