GU CA

Question 1

What high-risk features may prompt early initiation of ADT for biochemical recurrence? (3)

Answer 1

• Gleason 8 to 10 disease
• PSA doubling time less than one year
• Biochemical relapse less than 18 months following local therapy

Question 2

Name treatment options for high-volume mCSPC. (3)

Answer 2

1) ADT, docetaxel
2) ADT, docetaxel, darolutamide
3) ADT, docetaxel, abiraterone

Question 3

Name the treatment options for low volume mCSPC (3)

Answer 3

1) ADT +Abi
2) ADT + enza
3) ADT + apalutamide

Question 4

What are treatment options for nmCRPC?

Answer 4

1) ADT + Enzalutamide
2) ADT + Apalutamide
3) ADT + Darolutamide

Question 5

What are common genes implicated in homologous recombination repair that may indicate PARP inhibitor responsiveness (7)

Answer 5

BRCA1, BRCA2, PALB2,CHEK2,RAD51B, ATM, FANCA

Question 6

What defines Stage III RCC (2)

Answer 6

• node positive
• T3

Question 7

What defines high risk mRCC? (5)

Answer 7

• KPS <80
• time from dx to tx <12m
• Hb<12
• PLT >400
• WBC >12

Question 8

what are preferred tx for first line mRCC (4)

Answer 8

IPI / nivo (High risk)
Nivo / Cabo
Pembro / Axi
Pembro / lenvatinib

Question 9

What is the benefit of adjuvant pembrolizumab in stage III RCC?

Answer 9

Improved DFS only

Question 10

Who is a candidate for TMT for bladder CA?

Answer 10

T2-3a
N0
Low grade
No CIS
Unifocal

Question 11

What defines high Vs low risk non muscle invasive bladder CA (3)

Answer 11

Multiple lesions
Size >3cm
T1 (vs Ta)

Question 12

Tx of low risk non muscle invasive bladder cancer

Answer 12

TURBT

Question 13

Tx of high risk non muscle invasive bladder cancer

Answer 13

BCGx6 > TURBT > BCG x 3y

Question 14

What defines cisplatin eligibility in muscle invasive bladder CA? (4)

Answer 14

• EGFR > 60
• no hearing loss
• PS < 2
• NYHA CHF 2 or less

Question 15

Who should get adjuvant chemo for bladder cancer

Answer 15

• T2+ or n+ upstaged at cystectomy
• cisplatin eligible

Cisplatin Gemcitabine or ddMVAC

Question 16

What neoadjuvant regimens are used in bladder cancer?

Answer 16

Cisplatin - gemcitabine
ddMVAC

Question 17

When is adjuvant Nivolumab recommended in bladder CA?

Answer 17

Residual disease at cystectomy

Question 18

Metastatic urothelial cell tx (4)

Answer 18

• gem - cis (no prior platinum or >12m)
  
  • consider avelumab maintenance
• pembrolizumab
• Erdafitinib (FGFRmut)
• Enfortumab vedotin
• Sacituzumab govitecan

Question 19

What are the two biggest principles in muscle invasive bladder CA

Answer 19

1) cisplatin based regimens are the only option
2) neoadjuvant is preferred

Question 20

What is total medical therapy TMT for muscle invasive bladder cancer

Answer 20

Maximal TURBT
Rads
Cis or taxol

Question 21

Three factors needed to stratify risk for non metastatic prostate cancer

Answer 21

• grade group
• PSA
• T stage

Question 22

nmPC - define favorable prognosis

Answer 22

• grade group 1 (3+3=6)
• PSA < 10
• T1 or T2a

Question 23

nmPC - define high risk

Answer 23

Grade group 4/5
- Gleason 4+4
- Gleason 4+5 / 5+5
PSA > 20
T3 or T4

Question 24

nmPC - what defines intermediate risk? (Fav and unfav)

Answer 24

Grade group 2-3
PSA 10-20
T2b-3
Fav - <50% cores
Unfav - >50% cores

Question 25

Prostate cancer T staging

Answer 25

1 - imaging 2 - palpable 3 - extraprostatic ext 4 - invasion of other structures

Question 26

ADJ prostate cancer treatment

Answer 26

FAV - observation FAV-INT - obs or ADT x 6m UnFAV-INT - ADT x 6m HIGH - ADT x 18m

Question 27

Penile cancer treatment by stage - CIS - I/II (node negative) - III (node positive) - IV or recurrent

Answer 27

- topical - resection - resection w ILND (consider adj TIP but no data) - TIP or CRT with cisplatin

Question 28

How to evaluate an adrenal module

Answer 28

1) is it likely to be a met? If so stop here 2) if not, is it large or secretory? - evaluate for aldosteronism, bushings, pheo 3) if large, secretory, and unilateral respect

Question 29

Tx of pheocheomocytoma

Answer 29

Resection or cytoreductive subtotal resection if unresectable

Question 30

Tx or adrenocortical carcinoma

Answer 30

1) resection, consider mitotatne ( no OS benefit) 2) Mitotane based systemic therapy

Question 31

Tx for mCSPC

Answer 31

ADT with - doce - doce abi - doce dara - abi - apa - enza

Question 32

treatment for mCRPC (ASIs)

Answer 32

ADT with Enza Abi

Question 33

Define high volume metastatic prostate cancer

Answer 33

>4 lesions 1 extra axial lesion Visceral lesions

Question 34

What questions should you ask about every testis cancer?

Answer 34

1) seminoma or NSGCT 2) nodal status? I, IIA, IIB+ 3) risk Sem - m0-1 NSGCT - non pulm Mets, biomarker levels

Question 35

What defines favorable vs intermediate seminoma risk

Answer 35

Favorable Intermediate - non pulm Mets

Question 36

Define fav/int/high risk for NSGCT

Answer 36

FAV - INT - AFP>1k, hcg > 5k HIGH- mediastinal primary, non pulm Mets, AFP>10k, hcg>50k

Question 37

Treatment for stage I seminoma

Answer 37

Surgery then Obs > carbo x2 > RT

Question 38

Treatment for stage IIA seminoma

Answer 38

Surgery then 1) RT 2) BEPx3 or EPx4

Question 39

Treatment for stage IIB+ seminoma

Answer 39

Surgery then Fav risk - BEPx3 or EPx4 Int risk - BEPx4 or VIP x4

Question 40

Treatment for stage I NSGCT

Answer 40

Surgery then 1) observation 2) RPLND (esp if teratoma) 3) BEP x 1

Question 41

Treatment for stage IIA NSGCT

Answer 41

Surgery then 1) RPLND 2) BEP x3 or EPx 4

Question 42

What is residual disease after frontline treatment for seminoma and NSGCT? What are tx options

Answer 42

S >3cm mass - RT or RPLND NSGCT >1cm - RPLND