GU Flashcards

1
Q

Gleason Score

A

GS = sum of primary + secondary gleason grades. Scores <6 = not considered to be PC. Scores 8-10 = poorly differentiated, high risk disease

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2
Q

Staging for new PC diagnosis

A

Bone scan: sx suggestive of metastatic disease, GS 8 or more, T4 or T1 and PSA > 20, or T2 and PSA > 10

CT or MRI abdomen: T3, T4, or T1/T2 and nomogram predict LN involvement > 10%

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3
Q

Very low and low risk prostate cancer

A

Very low risk: T1c, PSA 10 or less, GS 6 or less, fewer than 3 prostate cores +, 50% or less cancer in any core, and PSA density <0.15ng/mg/g

Low risk: T1-T2a, PSA 10 or less, and GS 6 or less

If life expectancy < 10 years –> observe
If longer life expectancy –> active surveillance or definitive local therapy

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4
Q

High Risk Prostate Cancer

A

High risk: T3a or greater, pretreatment PSA > 20, or GS 8-10

Treatment = EBRT + ADT 1.5-3 yrs, EBRT + brachytherapy + ADT (1-3 years), or RP + pelvic LN dissection

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5
Q

Biochemical recurrence in prostate cancer

A

Biochemical recurrence after radical prostatectomy: serum PSA >0.2ng/mL with second confirmatory level >0.2ng/mL

Biochemical recurrence after definitive radiation: PSA rise by 2ng/mL or more above the postradiotherapy nadir. Of note, PSA usually nadirs within 1 yr after completion of radiation therapy

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6
Q

GnRH agonist versus GnRH antagonist

A

GnRH agonist = lupron

  • Continuous exposure of pituitary to GnRH causes transient surge in LH and thus testosterone before pituitary downregulates GnRH receptors resulting in decline in testosterone production
  • Give oral antiandrogen agent (bicalutamide) 1 week before to prevent this flare

GnRH antogonist = degarelix
-Given monthly, pt who needs immediate ADT and unable to wait week for antiandrogen lead in

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7
Q

Intermediate Risk Prostate Cancer

A

T2b-T2c, pretreatment PSA 10-20, or GS of 7

Treatment = EBRT +/- ADT 4 months, EBRT + brachytherapy +/- ADT (4 months), or RP + pelvic LN dissection (VERSUS if survival <10 years, observation is reasonable)

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8
Q

Risk profile for seminoma

A

Good risk: absence of extrapulmonary visceral mets

Intermediate risk: presence of extrapulmonary visceral mets

No poor risk category

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9
Q

Risk profile for non-seminoma

A

Good risk: testis/RP primary, S0-S1, absence of extrapulm mets (60%)

Intermediate risk: testis/RP primary, S2, absence of extrapulm mets (20-30%)

Poor risk: mediastinal primary, S3, non-pulmonary visceral mets (10-20%)

S1: LDH <1.5x normal and bHCG <5000, AFP >1000
S2: LDH 1.5-10x normal OR bHCG 5000-50,000, OR AFP 1000-10000
S3: LDH >10x normal OR bHCG >50,000, OR AFP >10000

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10
Q

Tumor Markers - risk levels in NSGCT

A

S1 = good risk
AFP <1K
HCG <5K
LDH <1.5x ULN

S2 = intermediate risk
AFP 1-10K
HCG 5-50K
LDH 1.5-10x ULN

S3 = high risk
AFP >10K
HCG > 50K
LDH >10x ULN
Also non pulmonary visceral mets and mediastinal mass
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11
Q

Prognostic Criteria for RCC

A

Clinical risk factors
<1 year from dx to systemic therapy
Poor PS/ECOG

Lab risk factors 
HyperCa
Neutrophilia 
Anemia
Thrombocytopenia

1 point per risk factor

Favorable = 0 points
Interm = 1-2 points
Poor = 3-6 points
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12
Q

Non-muscle invasive bladder cancer: how to decide about adjuvant therapy

A

Low risk = cTa low grade
–> intravesicular chemo single dose within 24 hours of TURBT

High risk = cTa, Tis, cT1
–> intravesicular immunotherapy (BCG) induction +/- maintenance and if BCG unresponsive then pembro approved

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13
Q

Treatment localized squamous cell of bladder

A

cystectomy +/- adjuvant chemo

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14
Q

Treatment for sarcamatoid/papillary kidney cancer

A

cabo
gem/sunitinib
gem/doxorubicin

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15
Q

Medullary kidney carcinoma

A

gem + platinum

related to sickle cell disease

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16
Q

chromosomal marker seen in 100% GCT

A

Isochromosome 12p amp seen in 100% GCT

17
Q

tumor marker half lives - AFP, HCG, LDH

A

AFP (7-10D)
HCG (2-3D)
LDH (2-3D)

18
Q

POOR risk non-seminoma adjuvant treatment

A

BEPx4
VIPx4
(not EP)

19
Q

Treatment Seminoma

A

Stage 1-2A:
Stage 1 –> observe or adjuvant RT
Stage 2A –> adjuvant RT or carbo (1-2 cycles)

Stage 2B-4:
Good risk –> BEPx3 or EPx4
Interm risk –> BEPx4, VIPx4

20
Q

Treatment Non-Seminoma

A

Stage 1-2A:
Stage 1 –> observe (preferred), RPLND, or BEP 1-2 cycles
Stage 2A –> RPLND or chemo (BEPx3 or EPx4) (if stage 1 or 2a after RPLND then observe, if more advanced - chemo)

Stage 2B-4:
Good risk –> BEPx3 or EPx4
Intermediate and Poor risk –> BEPx4, VIPx4

21
Q

cisplatin ineligible localized bladder cancer, what to do?

A

cystectomy

carboplatin is NOT alternative in neoadjuvant or adjuvant setting