Genitourinary Cancers
Core concepts
Prostate cancer: understand PSA screening controversy, Gleason grading/Grade Group, risk stratification, and treatment by stage-active surveillance for low risk, surgery or radiation for localized, androgen deprivation therapy (ADT) backbone for metastatic disease, with escalation using docetaxel, abiraterone, enzalutamide, or apalutamide. Know castration-resistant definitions and the role of PARP inhibitors in HRR-mutant disease and PSMA-targeted therapy. Renal cell carcinoma: clear cell histology, VEGF/TKI plus immunotherapy combinations for advanced disease, and the role of nephrectomy. Urothelial carcinoma: cisplatin eligibility, neoadjuvant chemotherapy before cystectomy, BCG for non–muscle-invasive disease, and immunotherapy maintenance after platinum. Germ cell tumors: tumor markers (AFP, beta-hCG, LDH), stage-based chemotherapy (BEP), and fertility counseling.
Traps
Questions test castration resistance definition (testosterone level plus progression), cisplatin eligibility criteria, and when to use BCG versus cystectomy. Watch for confusion between PSA recurrence and metastatic disease, and for the sequencing of ADT with novel agents.
Rule of thumb
In advanced prostate cancer, ADT is the backbone; add docetaxel or a novel hormonal agent for high-volume or high-risk metastatic disease up front.
Worked example
A man with metastatic castration-resistant prostate cancer and a BRCA2 mutation: a PARP inhibitor is a reasonable option, reflecting HRR mutation–directed therapy.