Prostate & Urologic Cancers Program

• Prostate cancer
• Bladder cancer
• Kidney cancer
• Upper tract urothelial cancer (cancer of the lining of the kidney’s drainage system or the ureters, the tubes that carry urine from the kidneys to the bladder)
• Testicular cancer
• Penile cancer
• Urethral cancer

Each patient’s case is reviewed by specialists in urologic surgery, medical oncology, radiation oncology, pathology, and diagnostic imaging. This collaborative approach helps us recommend the treatment that best fits your cancer, your health, and your priorities, such as protecting urinary and sexual function.

As part of Yale Cancer Center, a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, our patients also have access to clinical trials of new treatments.

Testicular cancer is one of the most curable cancers. More than 95% of patients are cured. More than half of cases in the United States occur in young men between the ages of 15 and 34, often after they find a new lump during a self-exam or a routine physical.

The earlier testicular cancer is diagnosed and treated, the better the chance of cure. If you notice a lump, swelling, or change in a testicle, contact your doctor. Our team works to confirm a diagnosis and begin treatment quickly.

Accurate diagnosis is the first step toward the right treatment. Our radiologists are experts in magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), fluoroscopy (real-time X-ray imaging), positron emission tomography (PET), and other nuclear medicine scans.

Targeted prostate biopsy

We use MRI/ultrasound fusion biopsy, which combines MRI images with real-time ultrasound to guide the biopsy needle to suspicious areas of the prostate. Compared with a standard biopsy, this approach has been shown to detect more clinically significant prostate cancers, meaning cancers that are more likely to need treatment. Our team uses the Artemis fusion system, which also allows doctors to return to the exact same spot in the prostate during follow-up biopsies. This is especially helpful for patients whose cancer is being monitored over time rather than treated right away—a process known as active surveillance.

Blue Light Cystoscopy

During a cystoscopy, a doctor uses a thin, lighted scope to look inside the bladder. Blue light cystoscopy uses a special dye and blue light to make bladder tumors easier to see, which can help doctors find and remove tumors that might otherwise be missed and lower the chance of cancer coming back.

Our urologic surgeons aim to remove or destroy cancer while preserving organs and protecting urinary and sexual function as much as possible. Options include:

• Minimally invasive and robotic surgery: Surgery performed through small incisions, which typically means less pain and a faster recovery than traditional surgery. Our surgeons are experienced in nerve-sparing techniques, which help protect erectile and urinary function after prostate surgery.
• Open surgery: Traditional surgery through a larger incision, used when it’s the best option for a patient’s cancer.
• Focal therapy for prostate cancer: For some men with cancer limited to one area of the prostate, focal therapy treats only the tumor rather than the whole gland. This can help preserve urinary and sexual function.
• Cryoablation: A procedure that destroys tumors by freezing them. It may be an option for some patients with kidney or prostate cancer.
• Laser treatment for upper tract tumors: For some patients with cancer of the ureter or upper urinary tract, a laser passed through a thin scope can treat the tumor while preserving the kidney.

Medical oncologists treat cancer with medicines, either alone or alongside surgery or radiation. Depending on the type and stage of cancer, treatment may include:

• Chemotherapy: For some cancers, such as bladder cancer that has grown into the bladder muscle, chemotherapy given before surgery can lower the chance of the cancer returning. Chemotherapy is also used to treat cancer that has spread.
• Immunotherapy: Medicines that help the immune system recognize and attack cancer cells. Immunotherapy is used for some kidney and bladder cancers.
• Targeted therapy: Medicines that act on specific features of cancer cells, used for some kidney and prostate cancers.

Our researchers also study new medicines and treatment combinations, and eligible patients can join clinical trials.

Radiation therapy uses high-energy beams to destroy cancer cells. Our radiation oncologists evaluate new radiation technologies and conduct research to improve treatment. Options include:

• Volumetric modulated arc therapy (VMAT) for prostate cancer: A precise form of radiation that shapes the beam to the tumor as the machine rotates around the body, helping limit radiation to nearby healthy tissue.
• Bladder-sparing treatment: For some patients with bladder cancer that has grown into the bladder muscle, a combination of tumor removal, chemotherapy, and radiation may be an alternative to removing the bladder.
• SpaceOAR hydrogel: A gel injected between the prostate and rectum before radiation that creates space between them. This helps protect the rectum from radiation side effects.

Theranostics combines advanced imaging with targeted radiation treatment. For prostate cancer, a PSMA PET scan first locates cancer cells that carry a protein called prostate-specific membrane antigen (PSMA). If the scan shows PSMA, a treatment called PSMA radioligand therapy may be recommended. During this treatment, a radioactive medicine, given through a vein, seeks out PSMA and delivers radiation directly to cancer cells while limiting damage to healthy tissue. Theranostics is currently used mainly for prostate cancer that has spread and no longer responds to other treatments. It can extend life, improve overall survival, and reduce pain when other traditional treatments stop working.

Our team of specialists, including medical oncologists, nuclear medicine experts, radiation safety specialists, and supportive care clinicians can help determine whether theranostics is an appropriate treatment for you. They also explain any temporary radiation-safety precautions needed after each treatment. Watch a webinar hosted by Smilow Cancer Hospital experts to learn more.

Holmium Laser Enucleation of the Prostate (HoLEP)

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive surgical procedure to treat benign prostatic hyperplasia (BPH), also known as enlarged prostate. During HoLEP, a surgeon uses a laser passed through a thin scope inserted into the urethra to remove prostate tissue that blocks urine flow. There are no incisions, and recovery is usually shorter than with traditional surgery. Studies show that HoLEP is safe, has a low rate of complications, and provides long-lasting relief from urinary symptoms.

Our genitourinary pathologists specialize in diagnosing cancers of the kidney, bladder, prostate, and testicles by examining tissue samples. Their detailed reports confirm the diagnosis and help predict how a cancer may behave, information your care team uses to guide treatment. Members of our team are recognized nationally and internationally for their work in classifying genitourinary cancers.

At Smilow Cancer Hospital, care goes beyond treatment. Advanced practice nurses who specialize in urologic cancers care for patients from diagnosis through treatment and follow-up. Patients and their families also have access to:

• Social workers, for emotional support and help with practical concerns
• Health educators
• Dietitians
• Complementary therapists

Genetic counseling and testing

Some urologic cancers, including some prostate and kidney cancers, can be linked to inherited gene changes that may also affect a person’s family members. Knowing whether you carry one of these changes can help guide your treatment and inform screening for relatives.

Patients have access to the Smilow Cancer Genetics and Prevention Program, whose team includes physicians, geneticists, genetic counselors, and advanced practice providers. Your care team can help you decide whether genetic testing is right for you.