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Egyptian Board Clinical Oncology study materials
Egyptian Board Clinical Oncology study resources

Egyptian Board Clinical Oncology: Genitourinary Oncology

Egyptian Board Clinical Oncology · Work through your exam, one topic at a time.

All guide sections

Genitourinary Oncology

What this domain tests

Genitourinary items span prostate risk stratification and the hormone-sensitive to castration-resistant transition, muscle-invasive bladder therapy, first-line kidney cancer combinations, and germ cell tumor risk classification with its curability caveats.

Core rules

  • Prostate risk groups combine PSA, Gleason/ISUP grade group and clinical T stage. Low risk may be managed with active surveillance; intermediate and high risk get radiotherapy with androgen deprivation or radical prostatectomy. Post-prostatectomy radiotherapy is indicated for positive margins or rising PSA.
  • Metastatic hormone-sensitive prostate cancer: ADT plus docetaxel (CHAARTED, greatest benefit in high-volume disease), or ADT plus abiraterone (LATITUDE), apalutamide or enzalutamide. High volume means visceral metastases or ≥4 bone lesions with at least one beyond the vertebral bodies and pelvis.
  • Castration-resistant disease: abiraterone, enzalutamide, docetaxel, cabazitaxel, radium-223 for bone-predominant disease, lutetium-177 PSMA-617 after prior therapy, and olaparib for BRCA-associated disease. Continue ADT throughout.
  • ADT toxicity: hot flushes, osteoporosis, metabolic syndrome, sarcopenia, sexual dysfunction - counsel and monitor bone density.
  • Bladder: non-muscle-invasive disease gets complete TURBT plus intravesical BCG for high-grade or T1 disease; muscle-invasive disease gets neoadjuvant cisplatin-based chemotherapy then cystectomy, or trimodality bladder preservation. Metastatic first line is enfortumab vedotin plus pembrolizumab or platinum-based chemotherapy.
  • Renal cell carcinoma: IMDC risk group determines first line - immunotherapy doublet or immunotherapy plus TKI for intermediate and poor risk; single-agent TKI for favorable risk in some frameworks. Cytoreductive nephrectomy is selective.
  • Germ cell tumors: IGCCCG risk grouping by histology, marker levels and site of metastases determines 3 or 4 cycles of BEP; seminoma is exquisitely radiosensitive and platinum-sensitive.

Worked example

A 68-year-old presents with prostate cancer, PSA 85, Gleason 9, and six bone metastases including two in the ribs. This is high-volume metastatic hormone-sensitive disease. ADT alone is inadequate; ADT plus docetaxel (six cycles) or ADT plus abiraterone with prednisone offers the survival benefit demonstrated in CHAARTED and LATITUDE.

Traps

  • Withholding docetaxel from low-volume disease where benefit is smaller, or giving it to patients unfit for cytotoxic therapy.
  • Stopping ADT when the disease becomes castration-resistant - it continues.
  • Using BCG in immunosuppressed patients or after recent TURBT with bleeding.
  • Omitting fertility counselling and sperm banking before BEP in young men.