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EAU, Chapter 3 MCQs
EAU · MBBS / Medicine · 22 practice questions
- Metastatic urothelial carcinoma - line of therapy
- MIBC management - treatment selection
- Radical cystectomy - perioperative recommendations
- Bladder-sparing treatment recommendations
- Primary urethral carcinoma - epidemiology and diagnosis
- Sexual-preserving radical cystectomy - patient selection
- Neoadjuvant therapy selection for muscle-invasive bladder cancer
- Cisplatin-based combination regimens in metastatic disease
1. A 55-year-old woman is undergoing pre-operative counseling before radical cystectomy for muscle-invasive bladder cancer. She has no significant comorbidities, favorable tumour characteristics, and demonstrates good coping ability during psychological assessment. According to guideline recommendations on urinary diversion and quality of life, what is the most appropriate diversion approach to offer her?
- AAny diversion type, since diversion choice has no bearing on quality of life outcomes
- BAn ileal conduit regardless of her favorable characteristics, since it is simpler to construct
- CA continent urinary diversion, since there are no clear contraindications present
- DCutaneous ureterostomy, as it best preserves quality of life in all patients
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C. A continent urinary diversion, since there are no clear contraindications present The guideline recommends offering a continent urinary diversion unless comorbidities, tumour variables, or coping abilities present clear contraindications, which this patient lacks. Choosing an ileal conduit or cutaneous ureterostomy by default ignores her favorable profile, and claiming diversion choice has no bearing on quality of life contradicts the emphasis on HRQoL determinants in diversion planning.
2. A 66-year-old man undergoes radical cystectomy for cT2N0M0 bladder cancer without any neoadjuvant therapy. Final pathology reveals pT3N0M0 disease. His oncologist is considering adding a checkpoint inhibitor to adjuvant cisplatin-based chemotherapy to maximize disease control. What is the most appropriate approach regarding checkpoint inhibitor use in this setting?
- ACheckpoint inhibitor immunotherapy should be added routinely alongside adjuvant chemotherapy for all pT3 disease
- BCheckpoint inhibitor immunotherapy should only be offered within a clinical trial setting
- CCheckpoint inhibitor immunotherapy should replace adjuvant chemotherapy as first-line adjuvant therapy
- DCheckpoint inhibitor immunotherapy should be reserved for patients who also received neoadjuvant chemotherapy
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B. Checkpoint inhibitor immunotherapy should only be offered within a clinical trial setting The guideline states immunotherapy with a checkpoint inhibitor should only be offered in a clinical trial setting in the adjuvant context, not routinely combined with chemotherapy, used as a replacement, or restricted to patients who received neoadjuvant therapy (which is unrelated to this indication).
3. A 68-year-old man is diagnosed with a T4b bladder tumour invading the pelvic sidewall with distant metastases. He presents with intractable gross hematuria and recurrent clot retention requiring transfusions. Which statement best reflects the appropriate role of radical cystectomy in his management?
- ARadical cystectomy should be deferred until after adjuvant chemotherapy is completed
- BRadical cystectomy should be performed with curative intent given his good functional status
- CRadical cystectomy may be offered as a palliative option to control his bleeding symptoms
- DRadical cystectomy is contraindicated in T4b disease under all circumstances
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C. Radical cystectomy may be offered as a palliative option to control his bleeding symptoms Primary radical cystectomy in T4b bladder cancer is not curative, but may be offered as a palliative/therapeutic option when symptoms such as intractable bleeding are present, which matches this patient's presentation. It is not universally contraindicated; palliative use is specifically endorsed for symptomatic patients. Curative intent surgery is inappropriate given T4b/metastatic status. There is no requirement to defer cystectomy until after adjuvant chemotherapy in this palliative symptomatic context.
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