GU Flashcards
Gleason Score
GS = sum of primary + secondary gleason grades. Scores <6 = not considered to be PC. Scores 8-10 = poorly differentiated, high risk disease
Staging for new PC diagnosis
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%
Very low and low risk prostate cancer
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
High Risk Prostate Cancer
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
Biochemical recurrence in prostate cancer
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
GnRH agonist versus GnRH antagonist
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
Intermediate Risk Prostate Cancer
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)
Risk profile for seminoma
Good risk: absence of extrapulmonary visceral mets
Intermediate risk: presence of extrapulmonary visceral mets
No poor risk category
Risk profile for non-seminoma
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
Tumor Markers - risk levels in NSGCT
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
Prognostic Criteria for RCC
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
Non-muscle invasive bladder cancer: how to decide about adjuvant therapy
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
Treatment localized squamous cell of bladder
cystectomy +/- adjuvant chemo
Treatment for sarcamatoid/papillary kidney cancer
cabo
gem/sunitinib
gem/doxorubicin
Medullary kidney carcinoma
gem + platinum
related to sickle cell disease
chromosomal marker seen in 100% GCT
Isochromosome 12p amp seen in 100% GCT
tumor marker half lives - AFP, HCG, LDH
AFP (7-10D)
HCG (2-3D)
LDH (2-3D)
POOR risk non-seminoma adjuvant treatment
BEPx4
VIPx4
(not EP)
Treatment Seminoma
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
Treatment Non-Seminoma
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
cisplatin ineligible localized bladder cancer, what to do?
cystectomy
carboplatin is NOT alternative in neoadjuvant or adjuvant setting
