Urological Cancers

Question 1

What are the two categories of prostate cancer?

Answer 1

castration sensitive and castration resistant disease

Question 2

What is the mainstay of treatment for castration sensitive disease?

Answer 2

androgen deprivation therapy

Question 3

What types of androgen deprivation therapy are available?

Answer 3

GnRH agonists (goserelin, leuprolide) and GnRH antagonists (degarelix)

Question 4

What is the issues with GnRH agonists?

Answer 4

They cause a ‘clinical flare’ in initial treatment because of transient flare of LH and increase in serum testosterone - can cause a flare in sx - don’t use in patients with extensive bony mets or risk of urinary retention

Question 5

What are poor prognostic factors in metastatic castration-sensitive disease?

Answer 5

de novo metasatic disease, high volume metasasis

Question 6

How should patients with poor prognosis in metastatic castration sensitive disease be managed?

Answer 6

adding another chemotherapy agent to the androgen deprivation therapy

Question 7

What is the treatment for castration-resistant prostate cancer?

Answer 7

chemotherapy, novel androgen receptor targeted therapies, radiopharmaceuticals, immunotherapy

Question 8

What are signs of poor prognosis in renal cell carcinoma?

Answer 8

poor performance status, high neutrophils, high platelets, high calcium, low Hb, less than 12 months between diagnosis and treatment initiation

Question 9

What are the three current treatment types for renal cell cancer?

Answer 9

Tyrosine kinase inhibitors, immunotherapy and mTOR inhibitors

Question 10

What are the side effects of tyrosine kinase inhibitors?

Answer 10

mucositis, stomatitis, diarrhoea, dry skin, rash, thyroid dysfunction, LFT derangement, arterial and venous thromboemoblism, QT prolongation, CCF, myocardial ischaemia

Question 11

What are the most common side effects/toxicities of immune checkpoint inhibitors?

Answer 11

colitis, pneumonitis, hepatitis, skin toxicities, endocrinopathies

Question 12

What is the role of nephrectomy in mRCC?

Answer 12

a recent study showed that sunitinib alone was non inferior to nephrectomy plus sunitinib - however if patient has symptomatic or large primary tumour may still be indicated

Question 13

What are the histological types of bladder cancer?

Answer 13

urotherlial carcinoma (90%), squamous (associated with schitosomiasis) and adenocarinoma

Question 14

Which anatomical type of bladder cancer is more agressive?

Answer 14

upper urinary tract

Question 15

Which type of bladder cancer requires radical surgery?

Answer 15

muscle invasive

Question 16

What is the alternative to radical cystectomy and which patients should you consider this for?

Answer 16

concurrent chemo-radiotherapy - consider in medically unfit patients

Question 17

Which type of chemotherapy agents have the greatest efficacy in advanced bladder cancer?

Answer 17

cisplatin

Question 18

What criteria make a patient cisplatin ineligible?

Answer 18

ECOG > 2, CrCl < 60, grade > 2 hearing loss, grade > 2 neuropathy, NYHA class III or greater HF

Question 19

What is the role of immune checkpoint inhibitors in bladder cancer?

Answer 19

PD-1 or PD-L1 inhibitors are used second line

Question 20

Is metastatic testicular cancer curable?

Answer 20

yes

Question 21

What are the two types of testicular cancer?

Answer 21

seminoma and non seminoma

Question 22

What factors denote high risk seminoma?

Answer 22

size > 4cm or rete testis invasion

Question 23

What is the management for early stage testicular cancer?

Answer 23

orchidectomy followed by active surveillance

Question 24

How should high risk seminoma be managed?

Answer 24

consider adjuvant chemotherapy (carboplatin) or radiotherapy (less commonly used)

Question 25

What factors denote high risk in non seminoma/

Answer 25

lymphovascular invasion or embryonal carcinoma

Question 26

What are the tumour markers for non seminoma?

Answer 26

AFP and beta HCG