Urologic Oncology
Core concepts
Know staging and risk stratification for prostate, kidney, bladder, and testicular cancers, plus the treatment logic that follows. Prostate: Gleason/ISUP grade group, PSA, D'Amico/NCCN risk, and when active surveillance is appropriate (low-risk, low-volume). Kidney: RCC subtypes (clear cell, papillary, chromophobe), TNM, partial vs radical nephrectomy, and the role of systemic therapy in metastatic disease. Bladder: non-muscle-invasive (TURBT + intravesical BCG for high-risk) vs muscle-invasive (neoadjuvant cisplatin-based chemo + radical cystectomy). Testis: seminoma vs nonseminoma, tumor markers (AFP, hCG, LDH), and retroperitoneal lymph node dissection indications.
Traps
Do not confuse grade with stage. High-grade T1 bladder cancer is high-risk and often needs re-TURBT and BCG. Muscle-invasive bladder cancer gets neoadjuvant chemotherapy - a common distractor is adjuvant radiation. For testis, AFP is never elevated in pure seminoma; if AFP is up, treat as nonseminoma. In renal masses, biopsy is not routine for a clearly malignant small mass in a surgical candidate.
Worked example
A 62-year-old with PSA 8, Gleason 3+3=6 (grade group 1) in 2 of 12 cores, clinical T1c: this is low-risk; active surveillance is a reasonable option. If the same patient had grade group 3 (4+4), treatment (surgery or radiation) is favored.
Exam strategy
Anchor on risk category, then choose management.