PANCE Blueprint Genitourinary (5%)

Neoplasms of the Genitourinary System (PEARLS)

The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint lists 5 types of GU neoplastic diseases

Bladder cancer A 70-year-old male retired leather worker, cigarette smoker; presents with painless gross hematuria

  • Painless hematuria in a smoker, 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 The diagnosis of penile carcinoma should be suspected in men who present with a penile mass or ulcer, particularly in those who are uncircumcised

  • The diagnosis requires biopsy for tissue confirmation

Treatment involves surgery for all stages of penile cancer. Other options include radiation and chemotherapy

Prostate cancer 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 a hard, irregular, and nodular

Tumor marker is PSA (also elevated in BPH)

  • PSA is considered normal < 4
  • PSA > 4 think BPH, prostate CA and prostatitis

Annual prostate cancer screening 

  • White male with average risk screen at 50 years old
  • Black male, positive family history, or + BRCA mutations - screen at 40 years old

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 A 22-year-old male who develops a right scrotal hydrocele with elevated serum β-HCG

  • Presents as a firm, painless, non-tender testicular mass and a feeling of heaviness in the scrotum
  • Seminoma is the most common type (60%)
  • Risk factors include a history of cryptorchidism
  • Diagnostic studies include ultrasound. Tumor markers: AFP, βHCG

Treatments include surgery, radiation, and chemotherapy

Urethritis (Lecture) (Prev Lesson)
(Next Lesson) Bladder cancer (Lecture)
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