PANCE Blueprint Genitourinary (5%)

• 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

• The diagnosis requires biopsy for tissue confirmation

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

• 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.

• 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