If you cannot pass urine at all, or have heavy bleeding with clots, seek emergency care now. Also seek urgent care for fever with loin pain, new leg weakness or difficulty passing urine with back pain, or fever during chemotherapy.
Three cancers of the urinary system with very different behaviour. Prostate cancer in particular is one of the few cancers where the right answer is often to monitor rather than treat.
Overtreatment is a genuine risk in prostate cancer. A man with low-risk disease who has surgery he did not need may live with incontinence and impotence for decades without any gain in life expectancy. This page tries to be honest about that.
Prostate cancer is common in older men, and much of it grows so slowly that it never causes harm. This is why treatment decisions depend on risk grouping — from the PSA level, the Gleason or ISUP grade on biopsy, and the stage on imaging. Low-risk disease is frequently monitored rather than treated, which avoids the incontinence and erectile problems that treatment can cause.
Bladder cancer usually presents with painless blood in the urine, which should always be investigated. Most is superficial at diagnosis and is treated by removing it through the urethra, followed by instillations of medication into the bladder. Because superficial bladder cancer recurs frequently, lifelong surveillance with cystoscopy is essential. Muscle-invasive disease is a different and far more serious situation requiring major surgery or radiotherapy.
Kidney cancer is increasingly found by accident on scans performed for other reasons, often at an early and curable stage. Surgery is the main treatment, and where possible only the affected part of the kidney is removed rather than the whole organ.
The unifying theme is that stage and grade drive the decision far more than the diagnosis label, and that for prostate cancer in particular, not treating is a legitimate and evidence-based option.
Low-risk prostate cancer — a low PSA, a low grade on biopsy, and disease confined to the prostate — is frequently best managed by active surveillance, with regular PSA testing, repeat biopsy and MRI. Treating it does not extend life in this group, and surgery or radiotherapy can cause long-term incontinence and erectile dysfunction. If you have been advised to have immediate surgery for low-risk disease, that warrants a second opinion. It is the one cancer where doing less is often doing better.
For prostate cancer, MRI before biopsy has changed practice considerably.
Multiparametric MRI performed before biopsy identifies the areas most likely to harbour significant cancer, allows targeted sampling, and can spare men with a normal scan from biopsy altogether. Biopsy without prior MRI risks both missing significant cancer and finding insignificant cancer that leads to unnecessary treatment. If a biopsy is being arranged without an MRI, ask why.
For prostate cancer especially, monitoring is a legitimate treatment rather than a failure to act.
Regular PSA measurement, repeat MRI and periodic biopsy, with treatment offered only if the disease shows signs of progressing. For low-risk disease this avoids the side effects of treatment without compromising survival, and a substantial proportion of men on surveillance never need treatment at all.
Surgical removal of the prostate, increasingly performed robotically, or radiotherapy with hormone therapy. Both are effective for localised intermediate and high-risk disease, with different side effect profiles — surgery carries more early incontinence, radiotherapy more bowel and urinary irritation later. Hormone therapy is central in higher-risk and advanced disease.
Superficial bladder cancer is removed through the urethra with no external incision, followed by BCG or chemotherapy instilled into the bladder to reduce recurrence. Regular cystoscopy surveillance afterwards is essential and lifelong, because recurrence is common.
Muscle-invasive bladder cancer requires removal of the bladder with urinary reconstruction, usually preceded by chemotherapy, or radiotherapy with chemotherapy where the bladder is to be preserved. Kidney cancer is treated by removing the tumour with a margin, preserving the rest of the kidney where possible, with targeted therapy and immunotherapy for advanced disease.
In prostate cancer, PSA, grade and stage together place you in a risk group, and that group determines whether treatment is needed at all.
Whether the tumour has invaded the muscle wall is the single decisive finding, and it comes from the resection specimen rather than from imaging.
Nerve-sparing prostate surgery, partial rather than total kidney removal, and bladder-preserving strategies all matter to how you live afterwards. Ask specifically about each.
For prostate cancer, ask what your risk group is and what the evidence says about treating it. If nobody can answer that clearly, get a second opinion before consenting to surgery.
Inability to pass urine needs a catheter locally, today. Heavy bleeding with clots needs local management before any travel is considered.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Possibly not. For low-risk, localised prostate cancer, active surveillance gives the same survival as immediate treatment while avoiding incontinence and erectile dysfunction — and many men on surveillance never need treatment. It depends on your PSA, your biopsy grade and your imaging. Send them and we will tell you which risk group you are in.
Some degree of urinary leakage is common in the early months and improves substantially in most men over the following year. Erectile function depends on whether the nerves can be preserved, which depends on the extent of the cancer, and on your function beforehand. Ask the surgeon for their own results rather than published averages.
Because superficial bladder cancer recurs frequently — it is the nature of the disease rather than a sign that treatment failed. Regular cystoscopy catches recurrences while they are still superficial and easily treated. Missing surveillance is how a manageable cancer becomes a muscle-invasive one.
Often, yes. Partial nephrectomy — removing the tumour and preserving the rest of the kidney — is standard for smaller kidney tumours and gives equivalent cancer control while protecting kidney function long term. This matters particularly if you have diabetes or high blood pressure. Ask specifically whether it is possible in your case.
A scan using a tracer that binds specifically to prostate cancer cells, making it considerably more sensitive than conventional bone scans and CT for detecting spread. It is available in Delhi NCR and is particularly useful in higher-risk disease and where PSA rises after treatment.
It offers less blood loss and a faster recovery than open surgery, with broadly comparable cancer control and continence outcomes in experienced hands. The surgeon's experience matters more than the platform. Ask how many robotic prostatectomies they perform each year rather than whether the hospital owns a robot.
Send the biopsy report with the grade, your PSA history, and the MRI or CT. For prostate cancer we will tell you your risk group and whether treatment is actually needed.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.