PANCE Blueprint Genitourinary (5%)

Neoplasms of the Genitourinary System (PEARLS)

PANCE Blueprint Genitourinary (5%)

The NCCPA™ PANCE Genitourinary Content Blueprint GU neoplastic diseases

Bladder cancer	Patient will present as → an 85-year-old man who comes to his primary care provider after a week of hematuria. He has not been ill lately and has had no complaints of pain on urination. A CT scan with contrast is ordered demonstrating a variable filling defect. Cigarette smoker Painless gross hematuria Transitional cell carcinoma is the most common type Cystoscopy with biopsy is the gold standard for initial diagnosis Treatments include surgery, biological therapy, and chemotherapy
Penile cancer	Patient will present as → a 63-year-old uncircumcised male with a painless lump on the head of his penis. Over the last two weeks, the lesion has been increasing in size, and three days ago, he began to notice a new foul-smelling discharge. On physical examination, you notice a 2 cm lesion on the prepuce and palpable inguinal lymphadenopathy. The diagnosis of penile carcinoma should be suspected in men who present with a penile mass or ulcer, particularly in those who are uncircumcised DX: The diagnosis requires biopsy for tissue confirmation TX: Treatment involves surgery for all stages of penile cancer. Other options include radiation and chemotherapy
Prostate cancer	ReelDx Virtual Rounds (Prostate cancer) Prostate cancer You are called to see an 85 y/o with back pain and constipation x 7 days Patient Gender: Male Age: 85 years Vitals Temperature: 98.1 F/36.7 C Blood Pressure: 145/62 Heart Rate: 62 Respiratory Rate: 16 Pulse Oximetry: 95% RA Signs and Symptoms Back pain; left-sided abdominal pain; no bowel movements for 7 days Click here to work through this patient case simulation. Patient will present as → a 68-year-old man comes to the clinic for a regular check-up. His PSA levels have been gradually increasing over the last few years and are now 11 ng/mL. A digital rectal examination reveals an asymmetrically enlarged prostate with an irregular, nodular consistency on the left side. A transrectal ultrasound-guided biopsy is performed, which confirms the diagnosis of prostate adenocarcinoma with a Gleason score of 7. The patient has no symptoms of urinary obstruction or bone pain. Symptoms include difficulty with urination, but sometimes there are no symptoms at all The most common area is the peripheral zone On DRE, carcinoma is characteristically hard, irregular, and nodular The tumor marker is PSA (also elevated in BPH) PSA is considered normal < 4 PSA > 4 think BPH, prostate CA, and prostatitis Prostate cancer screening (lots of debate here) USPSTF recommendations for prostate cancer screening: All men aged 55 to 69 years – the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Men 70 years and older – The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. Prostate-specific Antigen, Digital Rectal Examination, and Transrectal Ultrasonography If PSA level >10 ng/mL, TRUS with biopsy is indicated, regardless of DRE findings. If DRE is abnormal, TRUS with biopsy is indicated, regardless of PSA level. If PSA is <4.0 ng/mL and DRE is negative, annual follow-up is indicated If PSA is 4.1 to 10.0 and DRE is negative, a biopsy is usually recommended Some types of prostate cancer grow slowly. In some of these cases, monitoring is recommended Other types are aggressive and require radiation, surgery, hormone therapy, chemotherapy, or other treatments.
Testicular cancer	*Patient will present as →* a 32-year-old male presents with a painless, firm mass in his right testicle that he discovered 2 weeks ago. Serum tumor markers, including alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH) are elevated. Ultrasonography confirms the presence of a testicular mass. Orchiectomy reveals a mixed germ cell tumor. A 22-year-old male who develops a firm, painless, non-tender testicular mass with elevated serum β-HCG Most common solid tumor in young men ages 15-40 (average age 32 years old) Presents as a firm, painless, non-tender testicular mass, and a feeling of heaviness in the scrotum The most common type of testis cancer is a germ cell tumor There are two main types of germ cell tumors: seminoma and non-seminomatous germ cell tumors (NSGCT) Risk factors include a history of cryptorchidism DX: Diagnostic studies include ultrasound. Tumor markers: AFP, β-HCG, and LDH TX: Treatments include surgery, radiation, and chemotherapy Left testicular seminoma, hypoechoic nodule, ultrasound image

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