Urology Urologic Oncology: Review Questions Badrinath R. Konety, MD, MBA Dr. Konety is an Assistant Professor in the Departments of Urology and Epidemiology, University of Iowa, Iowa City, IA. Choose the single best answer for each question.
	1. A 22-year-old man presents with a left testicular mass and a serum ß human chorionic gonadotropin (ßHCG) of 8200 mIU/mL, a-fetoprotein (AFP) of 12,200 ng/mL, and a lactate dehydrogenase (LDH) level of 214 U/L. Radical orchiectomy reveals a mixed nonseminomatous germ cell tumor. Staging computed tomography (CT) scan reveals a 8-cm conglomeration of nodes in the para-aortic region (Figure 1). Chest radiograph demonstrates multiple bilateral pulmonary nodules, and a mass lesion in the frontal lobe is detected on CT scan of the brain. This places the patient in which one of the following risk categories? Excellent risk Good risk Intermediate risk Poor risk Cannot assign a category Click here to compare your answer. 2. What is the best chemotherapeutic regimen to treat this patient? Bleomycin, etoposide, and cisplatin (BEP) x 3 cycles BEP x 4 cycles Cisplatin, vinblastine, and bleomycin (PVB) x 3 cycles Etoposide and cisplatin (EP) x 4 cycles Salvage regimen with etoposide (VP-16), ifosfamide, and cisplatin (VIP) Click here to compare your answer. 3. A 54-year-old man is referred after having undergone a partial penectomy for a fungating mass on the left side of his glans penis. Histologic evaluation reveals a poorly differentiated squamous cell carcinoma of the penis invading into the corpus spongiosum (stage pT2). No nodes are palpable. What is the best choice for managing this patient’s penile cancer at this point? Observation and delayed left inguinal lymphadenectomy Immediate left inguinal lymphadenectomy and possible superficial and deep right inguinal lymphadenectomy if left side is positive Immediate bilateral superficial inguinal lymphadenectomy Immediate left-sided superficial lymphadenectomy and observation of the right side Delayed bilateral inguinal lymphadenectomy at the time of relapse Click here to compare your answer.		4. A 64-year-old man undergoes radical prostatectomy with pelvic lymphadenectomy after presenting with a serum prostate-specific antigen (PSA) level of 11.4 ng/mL and a prostate biopsy revealing Gleason 3+4 adenocarcinoma in 4/6 cores from the left prostate and 2/6 cores from the right prostate. Final pathologic analysis is Gleason 3+4, pT2b, N1, Mx. Preoperative bone scan is negative. What is the best course of management for this patient at this point? Continued observation with serial PSA levels Androgen ablation therapy with orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonists Radiation therapy to the prostatic bed Adjuvant androgen ablation therapy and radiation therapy to the prostatic bed Combined androgen blockage with antiandrogen (bicalutamide) and LHRH agonists Click here to compare your answer. 5. A 37-year-old man presents with a history of microscopic hematuria. CT scan reveals the presence of 2 exophytic, solid, contrast-enhancing 3-cm lesions in his right kidney and a 5-cm simple cyst in the left kidney. There is no lymphadenopathy or evidence of metastases. He undergoes wedge resections of both masses. What will the pathologic examination most likely reveal? Chromophobe renal cell carcinoma Clear cell carcinoma Oncocytoma Papillary renal cell carcinoma Transitional cell carcinoma Click here to compare your answer.
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