GU CA Flashcards
What high-risk features may prompt early initiation of ADT for biochemical recurrence? (3)
- Gleason 8 to 10 disease
- PSA doubling time less than one year
- Biochemical relapse less than 18 months following local therapy
Name treatment options for high-volume mCSPC. (3)
1) ADT, docetaxel
2) ADT, docetaxel, darolutamide
3) ADT, docetaxel, abiraterone
Name the treatment options for low volume mCSPC (3)
1) ADT +Abi
2) ADT + enza
3) ADT + apalutamide
What are treatment options for nmCRPC?
1) ADT + Enzalutamide
2) ADT + Apalutamide
3) ADT + Darolutamide
What are common genes implicated in homologous recombination repair that may indicate PARP inhibitor responsiveness (7)
BRCA1, BRCA2, PALB2,CHEK2,RAD51B, ATM, FANCA
What defines Stage III RCC (2)
- node positive
- T3
What defines high risk mRCC? (5)
- KPS <80
- time from dx to tx <12m
- Hb<12
- PLT >400
- WBC >12
what are preferred tx for first line mRCC (4)
IPI / nivo (High risk)
Nivo / Cabo
Pembro / Axi
Pembro / lenvatinib
What is the benefit of adjuvant pembrolizumab in stage III RCC?
Improved DFS only
Who is a candidate for TMT for bladder CA?
T2-3a
N0
Low grade
No CIS
Unifocal
What defines high Vs low risk non muscle invasive bladder CA (3)
Multiple lesions
Size >3cm
T1 (vs Ta)
Tx of low risk non muscle invasive bladder cancer
TURBT
Tx of high risk non muscle invasive bladder cancer
BCGx6 > TURBT > BCG x 3y
What defines cisplatin eligibility in muscle invasive bladder CA? (4)
- EGFR > 60
- no hearing loss
- PS < 2
- NYHA CHF 2 or less
Who should get adjuvant chemo for bladder cancer
- T2+ or n+ upstaged at cystectomy
- cisplatin eligible
Cisplatin Gemcitabine or ddMVAC
What neoadjuvant regimens are used in bladder cancer?
Cisplatin - gemcitabine
ddMVAC
When is adjuvant Nivolumab recommended in bladder CA?
Residual disease at cystectomy
Metastatic urothelial cell tx (4)
- gem - cis (no prior platinum or >12m)
- consider avelumab maintenance
- pembrolizumab
- Erdafitinib (FGFRmut)
- Enfortumab vedotin
- Sacituzumab govitecan
What are the two biggest principles in muscle invasive bladder CA
1) cisplatin based regimens are the only option
2) neoadjuvant is preferred
What is total medical therapy TMT for muscle invasive bladder cancer
Maximal TURBT
Rads
Cis or taxol
Three factors needed to stratify risk for non metastatic prostate cancer
- grade group
- PSA
- T stage
nmPC - define favorable prognosis
- grade group 1 (3+3=6)
- PSA < 10
- T1 or T2a
nmPC - define high risk
Grade group 4/5
- Gleason 4+4
- Gleason 4+5 / 5+5
PSA > 20
T3 or T4
nmPC - what defines intermediate risk? (Fav and unfav)
Grade group 2-3
PSA 10-20
T2b-3
Fav - <50% cores
Unfav - >50% cores
Prostate cancer T staging
1 - imaging
2 - palpable
3 - extraprostatic ext
4 - invasion of other structures
ADJ prostate cancer treatment
FAV - observation
FAV-INT - obs or ADT x 6m
UnFAV-INT - ADT x 6m
HIGH - ADT x 18m
Penile cancer treatment by stage
- CIS
- I/II (node negative)
- III (node positive)
- IV or recurrent
- topical
- resection
- resection w ILND (consider adj TIP but no data)
- TIP or CRT with cisplatin
How to evaluate an adrenal module
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
Tx of pheocheomocytoma
Resection or cytoreductive subtotal resection if unresectable
Tx or adrenocortical carcinoma
1) resection, consider mitotatne ( no OS benefit)
2) Mitotane based systemic therapy
Tx for mCSPC
ADT with
- doce
- doce abi
- doce dara
- abi
- apa
- enza
treatment for mCRPC (ASIs)
ADT with
Enza
Abi
Define high volume metastatic prostate cancer
> 4 lesions
1 extra axial lesion
Visceral lesions
What questions should you ask about every testis cancer?
1) seminoma or NSGCT
2) nodal status? I, IIA, IIB+
3) risk
Sem - m0-1
NSGCT - non pulm Mets, biomarker levels
What defines favorable vs intermediate seminoma risk
Favorable
Intermediate - non pulm Mets
Define fav/int/high risk for NSGCT
FAV -
INT - AFP>1k, hcg > 5k
HIGH- mediastinal primary, non pulm Mets, AFP>10k, hcg>50k
Treatment for stage I seminoma
Surgery then
Obs > carbo x2 > RT
Treatment for stage IIA seminoma
Surgery then
1) RT
2) BEPx3 or EPx4
Treatment for stage IIB+ seminoma
Surgery then
Fav risk - BEPx3 or EPx4
Int risk - BEPx4 or VIP x4
Treatment for stage I NSGCT
Surgery then
1) observation
2) RPLND (esp if teratoma)
3) BEP x 1
Treatment for stage IIA NSGCT
Surgery then
1) RPLND
2) BEP x3 or EPx 4
What is residual disease after frontline treatment for seminoma and NSGCT? What are tx options
S >3cm mass - RT or RPLND
NSGCT >1cm - RPLND
