Like any cancer, bladder cancer is caused by mutated cells that multiply and form a tumor, in this case in the bladder. For reasons that are not fully understood, bladder cancer affects men three to four times more often than women, with nine out of 10 cases of the disease occurring over the age of 55. The disease is more common in white men. The exact cause of bladder cancer isn’t always clear, but there are contributing factors that healthcare providers can point to. Besides male sex, white race, and older age, cigarette smoking remains the most significant risk factor for bladder cancer. Because many of the carcinogens in cigarettes are excreted from the body through the urine, constant exposure to these compounds can double the risk of bladder cancer compared to nonsmokers. In addition, the risk increases with the number of cigarettes a person smokes per day. Other factors for bladder cancer in men may include: Long-term exposure to industrial toxins (although the incidence has decreased as workplace safety has improved); Long-term use of cyclophosphamide chemotherapy; Radiation therapy for prostate cancer; Chronic urinary tract infections; Schistosomiasis, a parasitic infection common in the tropics Certain genetic mutations (particularly mutations of the FGFR3, RB1, HRAS, TP53, and TSC1 genes) may further predispose to bladder cancer. Having a history of cancer in a person’s family can also play a role, as rare inherited genetic disorders such as Lynch syndrome (linked to colorectal cancer), Cowden syndrome (linked to thyroid and breast cancer), and retinoblastoma (cancer of the eye) can potentially increase the risk of bladder cancer. Diagnosing bladder cancer is often complicated by the fact that many of its symptoms overlap with those of other, more common genitourinary diseases, including kidney stones and urinary tract infections. To this end, diagnosis relies heavily on ruling out all other causes of complaints before more invasive tests are performed. This may include a digital rectal exam (a mandatory part of any prostate cancer patient’s physical exam) and a prostate-specific antigen (PSA) test to rule out prostate problems. Imaging tests such as X-rays and computed tomography (CT) scans may be used to rule out kidney stones, bladder stones, and urinary tract disorders. While a urinalysis (the microscopic evaluation of urine to check for cancer cells) can provide evidence of cancer, the test is often inaccurate if the tumor is small and noninvasive. The same is true of newer options called urinary bladder tumor antigen and nuclear matrix protein 22 tests,and both are more likely to detect larger, more advanced tumors. These studies are more useful for follow-up of already diagnosed malignancy than establishing the initial diagnosis. References: 1. American Cancer Society. What is Bladder Cancer? 2. Harvard Medical School. Bladder cancer: Men at risk. 3. American Cancer Society. Bladder Cancer Signs and Symptoms. 4. Lotan Y, Choueiri TK. Patient education: Bladder cancer diagnosis and staging (Beyond the Basics) 5. Verywell Health. Bladder Cancer in Men Symptoms and Diagnosis