PANCE Blueprint Genitourinary (5%)

Neoplasms of the Genitourinary System (PEARLS)

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)
Patient will present as → a 71-year-old male who presents with nocturia, urgency, weak stream, terminal dribbling, hematuria, and lower back pain over the past four months. He has also experienced weight loss and fatigue.

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

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 who noticed a mass on his right testicle while showering. He reports this has never happened before and denies any pain or discomfort. On physical examination, there is a firm and fixed mass on the left testicle. Bilateral scrotal ultrasound is performed, and significant findings are seen here.

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

Urethritis (Lecture) (Prev Lesson)
(Next Lesson) Bladder cancer (Lecture)
Back to PANCE Blueprint Genitourinary (5%)

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