Uropathology is the pathology of male and female urogenital tracts, encompassing the kidneys, ureters (tubes leading from the kidney to the bladder) bladder, urethra (tube from bladder to outside) in men and women, and the penis, testicles, seminal vesicles and prostate in men. Cancers of the kidney, testicles and prostate are major causes of illness and death and are a major focus of TissuPath's expert pathologists.

Four of TissuPath's pathologists are members of our Uropathology Division, and they work closely with Prof Ronnie Cohen another internationally-recognized uropathologist in Western Australia and Director of Uropath Pty Ltd in Perth. Our uropathologists review thousands of prostate, kidney and bladder specimens every year, and are actively involved in teaching and research.

TissuPath is currently reviewing more than half of all the radical prostatectomy specimens from patients from Victoria.

Prostate cancer is an example of why specialist pathologists are important for proper care and optimal outcomes.

The possibility of prostate cancer is often raised by abnormal results on PSA testing and/or by digital rectal examination. However, a definitive diagnosis of prostate cancer requires histopathologic examination of prostate tissue. Small biopsies of parts of the prostate gland are obtained (usually by urologic surgeons or by specially-trained radiologists) under ultrasound guidance. These biopsies are then reviewed by TissuPath pathologists (after being prepared as described in 'What is Histopathology'.

It is the responsibility of TissuPath pathologists to determine whether prostate cancer is present in the biopsies, and if so, to determine how "aggressive" it is based on its appearance under the microscope. Aggressiveness of prostate cancer, as determined by a uropathologists, is summarized by the "Gleason Score". Unlike some other cancers, prostate cancer may be difficult to differentiate from normal prostate tissue, and determining the correct Gleason score is also difficult.

In some patients the prostate biopsies show very small areas of possible cancer, but the diagnosis cannot be made simply by microscopic examination of stained tissue. In these cases our pathologists look for the presence of specific protein markers of cancer by "staining" the tissue with specific antibodies to those proteins, so-called "immunohistochemistry", using the "PIN-4" antibody mixture.

TissuPath has recently established a new test which will help assess the "aggressiveness" of prostate cancer, especially those cancers detected at biopsy where the management strategy (surgery versus watchful waiting) is unclear).  Check the link above for further information.

Patients with prostate cancer have several treatment options. They may have surgery to remove (and often completely cure) the cancerous prostate, a "prostatectomy"; or they may have radiotherapy to control the cancer. Radiotherapy can be given using an external source of radiation or by implanting radioactive "seeds" in the prostate, so-called "brachytherapy". All of these can have serious side effects, and obviously should not be undertaken unless the diagnosis of cancer is definite. If biopsies showing prostate cancer are misdiagnosed as being normal, the prostate cancer may spread and become incurable.

As you can understand, the responsibility for accurate diagnosis places an enormous burden on TissuPath's uropathologists.

Kidney cancer, Bladder cancer, testicular cancer (the cancer that Tour de France winner Lance Armstrong had) are also relatively common cancers and can definitely be life-threatening; they require rapid and accurate pathologic diagnosis if suspected or if removed surgically.