Bladder tumours and an enlarged prostate often occur in the same men. Until recently, doctors have usually treated them separately, out of concern that operating on both at once might spread cancer cells. A study of more than 700 men now suggests that combining the two procedures is safe. This article explains how bladder tumours are diagnosed and what the evidence shows about treating a bladder tumour and TURP together.
How bladder tumours are found
Most people with a bladder tumour first notice blood in their urine. The usual investigations include urine and blood tests, a CT scan and a cystoscopy, in which a thin telescope is passed into the bladder to look inside. The NHS explains the symptoms and tests for bladder cancer.
Bladder tumours usually look like small growths, similar to polyps, on the bladder lining. Our article on the colour of urine and rapid diagnostic clinics explains why blood in the urine should always be checked promptly.
How they are treated
The first step is usually to remove the tumour using a telescope passed through the urethra, without any cuts to the skin. This procedure is called a transurethral resection of bladder tumour, or TURBT. The removed tissue is sent to the laboratory to confirm the diagnosis and show how deeply the tumour has grown.
The link with an enlarged prostate
In men, bladder tumours are often found alongside an enlarged prostate. Benign prostatic enlargement is very common with age and can cause a weak stream, frequent urination and waking at night to pass urine. Our page on benign prostatic enlargement explains the condition and its symptoms.
A long-established treatment for an enlarged prostate is transurethral resection of the prostate, or TURP. Like TURBT, it uses a telescope passed through the urethra, in this case to shave away excess prostate tissue from the inside.
The concern about combining them
Until now, doctors have been reluctant to remove a bladder tumour and shave the prostate in the same operation. The worry was that cancer cells from the bladder might be seeded into the raw surface left by the prostate surgery, increasing the chance of the cancer returning.
As a result, many men have had to undergo two separate procedures, each with its own anaesthetic and recovery.
What the study found
A study of more than 700 men, published in the British Journal of Urology International, compared outcomes when the two procedures were combined. It found that treating the bladder tumour and shaving the prostate at the same time was safe. In addition, the chance of the bladder cancer returning was actually lower in men who had both procedures together.
Professor Prokar Dasgupta described this as excellent news for patients, and a good example of evidence-based surgery replacing long-held assumptions.
What this means for patients
For men who have both a bladder tumour and an enlarged prostate, treating both in one operation can mean:
- a single anaesthetic rather than two
- one recovery period instead of two
- relief from urinary symptoms at the same time as cancer treatment
- no apparent increase in the risk of bladder cancer returning
Whether a combined procedure is suitable depends on the individual case, including the size and type of the bladder tumour and the size of the prostate. Other treatments for an enlarged prostate, such as Aquablation therapy, may also be considered in some situations.
Ongoing follow-up
After treatment for a bladder tumour, regular cystoscopies are needed to check that it has not returned. Your team will explain the follow-up schedule and what to look out for.
Our specialist areas page describes the conditions Professor Dasgupta treats. If you have been diagnosed with a bladder tumour or have symptoms of an enlarged prostate, please contact the clinic to discuss your options.