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Testis cancer remains the most common solid tumor in males 20–35 years of age and accounts for approximately 1 % of cancer cases in males. For unclear reasons, overall incidence has increased from 3.7/100,000 in 1975 to 5.4/100,000 in 2001 [1]. Fortunately, in the face of this trend, improved treatment success has resulted in a significant reduction in the mortality rate. In 2008, there were an estimated 8,000 new cases and 380 deaths from testis cancer in the United States [2]. The 5-year survival rate has increased from 83 % in the 1970s to 96 % by the end of the twentieth century due to the improvement in treatment [2].

Refinements in transrectal ultrasound biopsy over the last 25 years have led to improved cancer detection, fewer risks, and reduced morbidity. Hematuria, hematospermia, hematochezia, and rectal bleeding are common, but generally resolve without treatment. Anticoagulant medications should be stopped before planned biopsy unless contraindicated. For patients taking antithrombolytic therapy after cardiac stenting, the urologist should consult with the patient’s cardiologist to determine the best course of treatment. Infection complications are significantly reduced with prophylactic antibiotics. However, clinical studies show wide variances for optimal antibiotic regimen. Pain is a source of anxiety for many patients. Periprostatic nerve block is an established method for reducing discomfort. Patients should be educated about common postbiopsy conditions with low morbidity and be able to differentiate these from medical emergencies.

Understaging is a significant problem in the treatment of Urothelial Carcinoma of the bladder. Up to 70% of patients with perceived organ-confined tumors have been found to be understaged by the current clinical standard at the time of cystectomy. With advances in molecular biology, tumor markers that can detect and predict prognosis of patients with bladder cancer are emerging. Both urine and serum cancer markers that aid in differentiating between superficial and invasive bladder cancer are being investigated. This chapter examines the spectrum of predictive markers including microsatellite-associated markers, proto-oncogenes/oncogenes, tumor suppressor genes, cell cycle regulators, angiogenesis-related factors, extracellular adhesion molecules, and circulating serum markers. While no marker is yet a proven gold standard for predicting the extravesicular extension of bladder tumors, promising early data exists on bladder cancer markers that may differentiate those individuals with organ-confined disease from those with the poorer prognosis of more advanced cancer.

Prostate cancer remains the most common cancer type in men in the United States. Efforts are increasing to evaluate and discover diagnostic and therapeutic markers for prostate cancer patients. One of these, prostate-specific membrane antigen (PSMA), is a transmembrane protein highly expressed in all types of prostatic tissue, especially cancer. The radioimmunoconjugate form of the anti-PSMA monoclonal antibody (MAb) 7E11, known as the ProstaScint® scan, is currently being used to diagnose prostate cancer metastasis and recurrence. The antibody used in the ProstaScint scan recognizes an intracellular epitope of PSMA, making it most accessible in cells that are dead. The ProstaScint antibody is also a mouse antibody that can result in the generation of human anti-mouse antibodies (HAMAs). Therefore second-generation antibodies have been developed that are either genetically engineered humanized antibodies or are fully human antibodies that recognize the extracellular portion of the PSMA protein. Early promising results from various phase I and II trials have demonstrated the utility of PSMA as a target for both imaging and therapy.