The term malignant neoplasm refers to a new enlargement of tissue forming a tumor that invades a part or area and spreads to other areas. The condition often recurs after attempts at surgical removal, and it is also referred to as cancer. In this case, the malignant neoplasm involves the genitourinary (GU) system. This system includes the kidneys and urinary bladder as well as the organs of reproduction and their associated parts. For malignant neoplasms of the reproductive organs of women, (see Diagnostic Code: 7627 Malignant neoplasms of gynecological system or breast). The cancers most commonly seen in the male reproductive organs are of the prostate and testes.

Malignant genitourinary tumors may occur at any age in both sexes. Etiologies for the different organs found in both men and women, and those only in men are as follows:

• Kidneys - Unknown.

• Urinary bladder - Unknown.

• Prostate gland - Unknown.

• Urethra - Unknown, and rare.

• Penis - Unknown; however, the condition is more common in uncircumcised males who practice poor hygiene.

• Testes - Unknown; however, men of the white race and men with a history of cryptorchidism are more at risk.

For organs specific to women, see Diagnostic Code: 7627 Malignant neoplasms of gynecologic system or breast.

Manifestations related to organs found in both men and women, and those only in men are as follows:

• Kidneys - Blood in the urine (hematuria); flank pain; an abdominal mass; weight loss; fatigue; and intermittent fever are common symptoms.

• Urinary bladder - Hematuria; pus in the urine (pyuria); painful or difficult urination (dysuria); and burning and frequency of urination are common signs.

• Prostate gland - Signs and symptoms appear only in advanced stages of the disease. Signs are difficult urination; dribbling; urinary retention; unexplained infection of the bladder (cystitis); and hematuria. A hard lump in the prostate may be felt during a rectal examination. A nodule may be present prior to the appearance of other signs and symptoms.

• Urethra - Blood in the urine and a local mass are usually signs.

• Penis - Lesions on the penis are usually in the region of the corona (head) or beneath the foreskin.

• Testes - A mass in the scrotum, increasing progressively in size, and sometimes associated with pain, is a manifestation. A firm mass arising from the testis is cause for immediate clinical suspicion of a testicular tumor.

For organs specific to women, see Diagnostic Code: 7627 Malignant neoplasms of gynecologic system or breast.

Tests related to organs found in both men and women, and those only in men are follows:

• Kidneys - Abdominal ultrasound and computed tomography (CT) scan; magnetic resonance imaging (MRI); aortography; and selective renal angiography are common tests, coupled with palpation.

• Urinary bladder - Examination of the bladder, using a cystoscope, and biopsy of bladder tissue are aspects of the diagnosis. Other measures include abdominal ultrasound and CT scan, and MRI to assist in determining the stage of the cancer.

• Prostate gland - Prostate-specific antigen (PSA) testing may be used. Ultrasound may detect presence of a mass. Biopsy is used to confirm the diagnosis.

• Urethra - Biopsy is used to confirm the diagnosis.

• Penis - Tissue biopsy of the growth is used to determine the presence of a malignancy.

• Testes - Physical examination and ultrasound may localize the lesion in the testis. The diagnosis is established by exploration, and exposing and clamping the spermatic cord through a groin incision before mobilizing the tumor. Diagnostic studies include chest x-ray, and CT scan for determining the stage and possible spread of the cancer to other areas.

For organs specific to women, see Diagnostic Code: 7627 Malignant neoplasms of gynecologic system or breast.

Treatment related to organs found in both men and women, and those only in men are as follows:

• Kidneys - Radical nephrectomy (removal of the kidney with associated lymph glands), and radiation therapy are treatment measures.

• Urinary bladder - Transurethral resection (removal of a tumor using a cystoscope), radical cystectomy (removal of the bladder), and fulguration (electrical destruction of tissue) are used as treatments.

• Prostate gland - Treatments include: radiation; prostatectomy (surgical removal of the prostate gland); orchiectomy (surgical removal of the testes) to decrease hormone production; and hormone therapy. Radiation therapy and chemotherapy may also be indicated.

• Urethra - Radical surgery removing affected tissue will cause urinary diversion. Radiation, radical surgery or both combined have had variable results.

• Penis - Cancerous cells in this area are resistant to radiation, and chemotherapy is rarely effective. Early lesions may be cured by surgical removal of the penis (penectomy).

• Testes - Inguinal orchiectomy (removal of the testis through the groin), and combinations of chemotherapy and radiotherapy may also be required. Hormone replacement may also be required.

For organs specific to women, see Diagnostic Code: 7627 Malignant neoplasms of gynecologic system or breast.

Residuals related to organs found in both men and women, and those only in men are as follows:

• Kidneys - Prognosis for survival is good for single kidney cancer without lymphatic system involvement. When lymph system involvement is present, the survival rate is less than 15% at the five-year mark. If both kidneys are diseased, long-term dialysis or kidney transplant may be required.

• Urinary bladder - Where fulguration is used, it may have to be repeated at intervals for further developing tumors. Urine will have to be diverted if a radical cystectomy (removal of the bladder) is performed.

• Prostate gland - Potential sexual dysfunction, hormone replacement therapy, and difficult or uncontrolled urination are potential side effects. In addition, prostate cancer frequently produces metastasis to the bone.

• Urethra - Potential sexual dysfunction and urinary diversion are possible residuals. Prognosis depends on the extent of the cancer and the part of the urethra affected.

• Penis - Penectomy, either partial or total, could result in impairment of function. Partial penectomy, which leaves a penile stump, can provide for satisfactory urination and sexual activity.

• Testes - Prognosis for survival depends on cell involvement and the extent of the tumor. Life-long hormone replacement may be required, and reproduction capability may be lost.

• This disease, (condition), only in its active form , has a 1 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a) [chronic disease].

• Malignant neoplasms of the urinary tract (specifically kidneys, renal pelves, ureters, urinary bladder and urethra) shall be service connected if the Veteran was in a radiation risk activity as defined by 38 CFR 3.309 [Disease subject to presumptive service connection, 38 CFR 3.309(d), Diseases specific to radiation-exposed Veterans] provided the rebuttable presumption provisions of 38 CFR 3.307 of this part are also satisfied; or for any malignant neoplasm of the genitourinary system, including prostate cancer, under 38 CFR 3.311 [Claims based on exposure to ionizing radiation], and 38 CFR 3.311(b) [Initial review of claims] provided the provisions of §3.311(b)(5)(iv) have been met. A claim under 38 CFR 3.311 that involves radiation exposure requires an opinion by the C&P Service before any decision may be made by a Regional Office to grant or deny benefits.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

• If a Veteran was exposed to an herbicide agent during active military, naval, or air service, prostate cancer shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.307(d) are also satisfied. [See 38 CFR 3.309(e) - Disease associated with exposure to certain herbicide agents]

• If a Veteran, or former reservist or member of the National Guard, was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of 38 CFR 3.307(a)(7), certain diseases shall be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of 38 CFR 3.307(d). 38 CFR 3.309(f)

• When making examination request, make sure the examiner provides the Veteran's current symptoms due to residuals etc.

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

• Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105(e) of this chapter. If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.