Genitourinary

Question 1

Low Risk Prostate (T, Gleason, PSA) Diagnostic Criteria and Treatment

Answer 1

Dx: ALL of the following
- cT1–T2a
- Grade Group 1 or Gleason score ≤6 AND
- PSA <10 ng ml
Treatment:
a. Repeat testing to confirm if appropriate for AS
b. RT
c. RP

Question 2

Unfavorable Intermediate Risk Prostate Cancer Diagnostic Criteria

Answer 2

Has 2 or 3 IRF ONLY:
- cT2b–cT2c ( more than 1/2 or in both prostate lobes)
- Grade Group 3
- > 50% cores positive
- PSA 10- 20 ng/mL

Question 3

Favorable Intermediate Risk (T, Gleason, PSA) Diagnostic Criteria

Answer 3

Has ALL of the following:
a. 1 IRF
b. Grade Group 1 or 2 (Gleason 6 or Gleason 3 +4)
c. <50% biopsy cores positive (eg, <6 of 12 cores)

Question 4

Favorable Intermediate Risk (T, Gleason, PSA) Treatment

Answer 4

a. Active Surveillance
b. RT
c. RP +/- pelvic LN dissection

Question 5

Unfavorable Intermediate Risk Prostate Cancer Treatment

Answer 5

a. RP + RPLD
- if LN positive or adverse features*, can treatment with adjuvant ADT +/- EBRT or once detectable PSA with salvage RT +/- ADT
b. RT + ADT 4-6 months
*Adverse laboratory/pathologic features include: positive margin(s); seminal vesicle invasion; extracapsular extension; or detectable PSA.

Question 6

High Risk Prostate Cancer Treatment

Answer 6

a. RT + ADT 2-3 years
b. RP + PLND

Question 6

High Risk Prostate Cancer Diagnostic Criteria

Answer 6

Has ONLY ONE high-risk feature:
- cT3a (EPE but NO SVI)
- Grade Group 4 or Grade Group 5
- PSA >20 ng/mL

Question 7

VERY High Risk Prostate Cancer Diagnostic Criteria

Answer 7

Has at least ONE of the following:
* cT3b–cT4 (SVI or invasion or other structures)
* Primary Gleason pattern 5
* 2 or 3 high-risk features (GG4 or 5, PSA> 20, cT3a)
* >4 cores with Grade Group 4 or 5

Question 8

VERY High Risk Prostate Cancer Treatment

Answer 8

a. RT + ADT (2-3 yrs) + Abiraterone 2 yrs
b. RP + PLND
- If adverse features ADT + EBRT

Question 9

Pathogenic Mutations approved for use of Olaparib in CRPC (13) & in what setting is it used

Answer 9

A. Somatic or Germline Mutations:
BRCA1, BRCA2
ATM
BARD1
BRIP1
CDK12
CHEK2
FANCL
PALB2
RAD51B, RAD51C, RAD 51D or RAD54L.

B. Approval for use: HRR gene-mutated metastatic castration-resistant prostate cancer (mCRPC), who have progressed following prior treatment with enzalutamide or abiraterone and taxane based chemotherapy

Question 10

Pathogenic mutations approved for use of talozoparib (12) & in combination with which anti-androgen

Answer 10

A . HRR mutations include a germline and/or somatic mutations:
- BRCA1, BRCA2
- ATM, ATR
- CDK12
- CHEK2
- FANCA
- MLH1
- MRE11A
- NBN
- PALB2
- RAD51C

B. Approval for use with Enzalutamide

Question 11

Low Risk NMIBC Criteria (4)

Answer 11

A. Papillary urothelial neoplasm of low malignant potential
B. Low grade urothelial carcinoma + ALL of the following:
- Ta, 3 cm, + Solitary

Question 12

Intermediate Risk NMIBC:
A. Diagnostic criteria for low grade
B. Diagnostic criteria for high grade
C. Clinical Management

Answer 12

A. Low grade urothelial carcinoma + any of the following:
- T1, 3 cm, Multifocal OR Recurrence within 1 year
B.. High grade urothelial carcinoma + ALL of the following:
- Ta + ≤3 cm + Solitary
C. Management: Intravesical chemotherapy (preferred) OR surveillance

Question 13

High Risk NMIBC:
A. High risk diagnostic criteria
B. Very high risk diagnostic criteria
C. Clinical Management of high and very high risk NMIBC

Answer 13

A. High grade urothelial carcinoma: ANY of the following plus
- CIS or T1, 3 cm, OR Multifocal

B. Very high risk features: ANY of the following
- BCG unresponsive
- Variant histologies
- Lymphovascular invasion
- Prostatic urethral invasion

C. Management:
- High grade: BHCG (preferred)
- Very High Risk: Cystectomy (preferred)