Urologic Oncology
What this domain tests
This domain tests staging, risk stratification, tumor markers, and treatment selection across kidney, bladder, prostate, testicular, penile, and adrenal tumors. Questions often ask which test establishes diagnosis, which finding changes stage, and when surgery, immunotherapy, or systemic therapy is appropriate.
Core rules and concepts
- Renal cell carcinoma subtypes include clear cell, papillary, and chromophobe; staging uses tumor size, venous invasion, perinephric fat, and metastases. Small incidental masses may be observed or treated with nephron-sparing surgery.
- Bladder cancer is usually urothelial. Non–muscle-invasive disease is managed with transurethral resection and risk-based intravesical therapy, including BCG for high-risk disease; muscle-invasive disease requires radical cystectomy or trimodality therapy.
- Prostate cancer risk uses PSA, Grade Group, and stage. Grade Group 1 is Gleason 3+3; higher groups carry worse prognosis. MRI-targeted biopsy improves detection of clinically significant cancer.
- Testicular germ-cell tumors are seminoma or nonseminoma. Obtain AFP, beta-hCG, and LDH before radical inguinal orchiectomy; avoid scrotal violation.
- Penile cancer is usually squamous; inguinal nodal staging matters. Adrenal masses require hormonal evaluation when pheochromocytoma is possible.
Worked example
A 62-year-old man has PSA 8 ng/mL and a firm prostate nodule. Reasoning: obtain MRI and targeted plus systematic biopsy, then assign Grade Group and clinical stage. A negative biopsy does not exclude cancer when MRI and DRE are suspicious; repeat evaluation may be needed.
Traps
Do not biopsy a testicular mass through the scrotum. Do not omit tumor markers before orchiectomy. Do not treat an adrenal incidentaloma before excluding pheochromocytoma.