Genitourinary Malignancies (Exam 3)

Question 1

Prevalence of Prostate cancer in men

Answer 1

1/9

Question 2

Number of men that will die from prostate cancer

Answer 2

1/41

Question 3

Race that has 1/4 with 2-3 times higher or mortality with prostate cancer

Answer 3

African American men

Question 4

Increased risk with first-degree relative w/ prostate cancer

Answer 4

2.5 x higher risk

Question 5

What are two common associations with prostate cancer

Answer 5

BRCA / BRCA2
and
Lynch syndrome

Question 6

Screening tool for Prostate Cancer

Answer 6

PSA - Prostate Specific Antigen Test

-anything that irritates the prostate can increase the PSA number- there are a lot of things, such as masturbation with ejaculation, infection, catheter placement, and anything that will agitate the prostate

Question 7

True or False PSA only comes from prostate tissue

Answer 7

False- even women can produce PSA …

Question 8

PSA is used with no controversy at all…

Answer 8

NO- false there has been significant controversy around the testing.

Question 9

There is a screening recommendation of the AUA to screen PSA when

Answer 9

all men aged 59-69 1-2 years and earlier or later depending on history, risk, life expectancy

Question 10

What is a classically normal PSA

Answer 10

< 4.0

Question 11

average ranges of PSA for adults

Answer 11

40-49 < 2.5
50-59 < 3.5
60-69 < 4.5
70+ < 6.5

Question 12

True or False- DRE is enough to screen for prostate cancer

Answer 12

False- Prostate examinations alone are not adequate for catching prostate cancer in your pt’s

Question 13

Management strategy’s for Prostate cancer

Answer 13

Watchful waiting / active surveillance

Androgen deprivation- not trying to cure cancer just maintain it as low as possible (this can suppress cancer growth from 3-10 years)

Definitive treatment- Open or laparoscopic surgical excision (radical prostatectomy ) or radiation

Complicated cases- sx with external beam radiation

Other options exist including newer and older focal therapies

Question 14

Complications from prostate caner treatment

Answer 14

Symptoms with low testosterone (low energy, fatigue, hot flashes)

sx causes stress incontinence (leakage of urine with coughing, sneezing, exercise) and impotence

Radiation can cause some incontinence, though usually les, impotence, as well as irritation to the bowel or bladder leading to urgency of urine or bowels, with or without leakage

Focal therapies also cause impotence commonly

Question 15

Fourth most common cancer in men

Answer 15

Bladder cancer

Question 16

Bladder caner affects men at ____ and women at ______

Answer 16

1/27 1/89

Question 17

Most common cause of Bladder cancer

Answer 17

Smoking

Question 18

Presentation of Bladder Cancer includes:

Answer 18

Painless Hematuria (gross or microscopic)

Rarely causes pain although it can

DDX- UTI, ureteral or kidney stones, UTI structure disease

Question 19

Significant hematuria is considered to be what on microscopy

Answer 19

> 3 RBC’s on high field.

Dipsticks can be fooled… so if you test positive you need to have a collection sent for microscopy

Question 20

Lower urinary tract includes

Answer 20

anything from the bladder and down

Question 21

Upper urinary tract includes

Answer 21

everything above the bladder

Question 22

What are the minimal things needed before you refer to a Urologist

Answer 22

A negative culture grown, and UA with microscopy

Question 23

Mainstay of treatment of Bladder cancer

Answer 23

Surgical resection of tumor

Question 24

True or false- Small tumors can be treated outside of the hospital just in office

Answer 24

True - however large tumors need same-day surgery or admission to hospital

Question 25

______ is utilized for recurrent disease with Bladder cancer

Answer 25

BCG or ( mitomycin C )

Question 26

14th most common cancer globally

Answer 26

Renal cell carcinoma

Question 27

What is the etiology of Renal cell carcinoma

Answer 27

Idiopathic and unknown in most cases

Question 28

Renal Cell Carcinoma Presentations

Answer 28

Classic Triad: Gross hematuria, flank pain, palpable flank mass This is only in 10 percent of cases that you will see these all arise together.

Question 29

Gold standard for imaging of Renal Cell carcinomas

Answer 29

CT scan

Question 30

Where is the most likely metastasis of Renal cell carcinoma

Answer 30

Lung tissue. Warrants a CXR or CT of chest fi cancer found in kidneys

Question 31

Renal Cysts

Answer 31

Cysts of the kidneys are very common. (10% of all people)

Question 32

Typically we find Cysts how

Answer 32

incidental findings

Question 33

simple cysts are not harmful at all. Do not progress to malignancy and require no further imaging. However, what kind of cysts do need further workup

Answer 33

Complex cysts. They do carry some risk for malignancy and require referral to Urology to assess the risk

Question 34

what does a complicated cyst mean

Answer 34

might have calcium components of the will. they . might have very thick sub area with walls or multiple sub sets not jsut one large open cyst.

Question 35

post removal of a kidney or part of a kidney what is an expected bump in the Cr that is expected

Answer 35

50% immediate bump.

Question 36

what is the most common cancer in men aged 18-35

Answer 36

Testicular cancer

Question 37

Testicular cancer how many pts will get this

Answer 37

1/250 pts in their lifetime

Question 38

Is Testicular cancer is typically unilateral or bilateral ?

Answer 38

Unilateral

Question 39

You do not need a biopsy to diagnose testicular cancer true or false

Answer 39

True . it is one of the diseases that can be diagnosed based off of

Question 40

Why should you never biopsy testicular cancer but must biopsy bladder tumors?

Answer 40

because the tumors of the testicle are at a high risk of spread if biopsied

Question 41

Primary care providers should do what prior to sx

Answer 41

Tumor markers need to be drawn and LDH

Question 42

Most testicular cancers show what type of pathology typically

Answer 42

Some combination of (seminoma, yolk sac tumor, choriocarcinoma, embryonal, teratoma)

Question 43

low grade non- seminomatous cancers are usually treated with adjuvant chemotherapy how are high grade cancers often treated

Answer 43

High grade cancers often require retroperitoneal lymph node dissection (RPLND). not done routinely by genaral urologists (they take the lymph nodes from way down all the way up to inguinal region)

Question 44

Suspicious testis are Urgent or non-Urgent

Answer 44

Urgent- very rapid growth. There are very small windows of to which they can take care of keeping the cancer growth low.