Urologic Oncology
Prostate cancer
PSA is organ-specific, not cancer-specific; confirm abnormal values and consider BPH, prostatitis, instrumentation, and ejaculation. Risk stratification combines PSA, ISUP grade group, and clinical stage. ISUP 1 = Gleason 3+3, 2 = 3+4, 3 = 4+3, 4 = 4+4, 5 = 9–10. Group 3 behaves distinctly worse than group 2, a favourite exam distinction. Low-risk disease may be managed with active surveillance; high-risk disease needs local therapy plus systemic treatment.
Kidney and bladder
Clear-cell RCC predominates; partial nephrectomy is preferred for T1 tumours when technically feasible, and small masses in frail patients may be observed. Bladder cancer is risk-stratified by grade, stage, size, multiplicity, CIS, and recurrence pattern. TURBT must include detrusor muscle. BCG is standard for high-risk NMIBC but is contraindicated in immunocompromised patients and is withheld during gross haematuria or after traumatic catheterisation.
Testis
Germ-cell tumours are seminoma or non-seminoma; markers are AFP, hCG, and LDH. Pure seminoma never secretes AFP, so an elevated AFP means non-seminomatous elements regardless of reported histology. Markers are drawn before orchiectomy, and staging uses CT.
Traps
Confusing grade group 2 with 3; treating biochemical recurrence without confirmation; forgetting that upper-tract urothelial carcinoma is staged like bladder cancer and requires contralateral evaluation; assuming a renal mass is RCC without considering oncocytoma or metastasis.
Worked example
A man with PSA 8 and Gleason 4+3 has ISUP grade group 3, not 2, and is not low-risk because the pattern 4 component dominates.