Clinical Approach to Renal, Bladder, Penile, Testicular & Prostate Cancer -Testicular Cancer

Question 1

RCCA Epi

Answer 1

• 50-60s YO
• 2X M>F
• Hispanic > White = Black

Question 2

RCCA clinical triad

Answer 2

• Gross Hematuria
• Flank Pain
• Palpable Mass

Question 3

PNPS related to RCCA

Answer 3

• Cushings’s Syndrome
• Protein enteropathy/ Enteroglucagon
• Prolactinemia
• Insulinemia
• Gonadotropinemia

Question 4

RCCA Staging

Answer 4

Stage I: <7 cm
Stage II: >7 cm
Stage III: contained in Gerota’s Fascia; spread via IVC
Stage IV: Spread to other organs + LNs

Question 5

Prostate CA EPI

Answer 5

• > 40 YO

- Black > White > Japanese

Question 6

PSA Test

Answer 6

Normal 0-4 ng/ml

“gray zone” 4-10

Question 7

Who should get PSA screening?

Answer 7

55-69 YO w/ average risk + asymptomatic

*Not recommended for 70 YO or more w/ LE less thatn 10 yrs

Question 8

2017 AUA Guidelines

Answer 8

Very Low/Low: Gleason 1; PSA < 10

Intermediate: Gleason 7/Stage 2b; PSA 10-20

High Risk: Gleason >8; PSA > 20

Question 9

Management of advanced metastatic cancer

Answer 9

• Orchiectomy
• LH-RH Agonist
• Gn-RH Antagonist
• Antiandrogens

Question 10

Asymptomatic ptsd w/ PCA no longer responding to hormone Tx

Answer 10

Provenge

Question 11

Castration-resistant PCA Tx

Answer 11

Zytiga with presnisone

Or

Taxotere

Question 12

Testicular Cancer ETI

Answer 12

• Undescended testes/Cryptorchidism
• Exogenous estrogen administration to mother during pregnancy
• trauma + Infx

Question 13

Testicular CA S/S

Answer 13

• painless enlargement
• acute testicular pain (rare)
• S/S of metastatic disease (rare)
• gynecomastia

Question 14

Testicular tumor workup

Answer 14

• Biochem markers (AFP, hCG, LDH)
• Scrotal US
• CT to assess metastasis
• inguinal orchiectomy

Question 15

Scrotal CA Tx

Answer 15

• Radical Orchiectomy
• Low-stage Seminoma -> Irradiation
• High stage Seminoma -> ChemoTx
• Low stage NSGCT -> RPLND or surveillance
• High-stage NSGCT -> ChemoTx; resection of residual mass

Question 16

Metastasis of the testis

Answer 16

• Lymphoma
• Leukemia
• prostate

Question 17

Bladder CA EPI

Answer 17

• M:F 2.8:1
• White> Others
• ~65 YO

Question 18

Bladder CA S/S

Answer 18

• Hematuria
• Sometimes No other physical signs
• Anemia
• Fish Test
• RFT - Azotemia

Question 19

Bladder CA Assessment + Tx

Answer 19

• Cystoscopy -> Assess invasion of wall

- Complete excision of low-stage lesions (TUR-BT)

Question 20

Intraveiscal chemo/Immuno Tx

Answer 20

• BCG
• BCG w/ Intron
• Thiotepa
• Mitomycin C
• Doxorubicin
• Valstar