When it has spread: prostate and bladder

Four cancers, four different labels underneath the word advanced. Adjuvant platinum after nephroureterectomy and why POUT’s survival claim is weaker than it is usually quoted; CARMENA and the narrow place cytoreductive nephrectomy still holds; why you say which kidney risk model you used; the retroperitoneal node dissection, where the template depends on the side and the chemotherapy depends on the risk group; what is actually injured when ejaculation fails afterwards; when rising markers mean salvage chemotherapy rather than surgery; why clinical N3 penile cancer never starts with the knife; and one drug that is standard of care in one of these cancers and a strong recommendation against in another.

Metastatic is not one state but a word covering several, and the examinable skill is naming which one you are in before you reach for a drug. The four states of prostate cancer and why the word changes the treatment; why you check the testosterone before saying castration-resistant; high volume against low volume by CHAARTED, and the two opposite directions it pushes you; why the doublet rather than the triplet carries the strong recommendation; the three bladder words that are not synonyms; what BC2001 really showed about chemoradiotherapy; first-line metastatic disease after EV-302; and the platinum trap, where carboplatin substitutes and where it must never.

The best place to begin: the highest-yield topic in the exam, at the pace the rest of the series runs. What the screening trials really show and why they only look contradictory, the MRI-first pathway and biparametric scanning, why the biopsy left the operating theatre, the T2 change people miss, who actually needs staging imaging, why three surgery-versus-monitoring trials disagree, when a benign biopsy is not reassuring, and the two recurrence definitions you must not mix up.

The haematuria pathway now it is risk-stratified, why the chest scan you were taught to order has largely gone, where NICE and the EAU genuinely disagree on follow-up, what counts as BCG failure and what you can offer when it happens, muscle-invasive disease including the chemotherapy substitution that costs a cure, first-line metastatic treatment, who needs a second resection, and why the upper tract behaves differently.

Choosing by the patient rather than the tumour in the small renal mass, what the Bosniak system is actually measuring and where surgery overtreats, when a biopsy helps and the scan that reads mitochondria, the one piece of biology that explains why the drugs work, why removing the kidney in metastatic disease is no longer automatic, and a safe approach to the adrenal incidentaloma.

The infected obstructed kidney and the stent you should not place, why five to six millimetres decides so much, why you should not believe a patient who says the stone has passed, what the expulsive therapy evidence really says, what PUrE changed for lower pole stones, how the rules reverse in pregnancy, why restricting dietary calcium makes things worse, and the two stones where chemistry is the treatment.

The impalpable lesion on a scan and whether he needs to lose a testis to find out, tumour markers that mislead in both directions, fertility and the retrieval option people forget, how the prognostic groups actually work, stage one and the surveillance-or-treat decision, what to do with what is left after chemotherapy, the lumps that are not germ cell tumours, and why a node dissection costs ejaculation.

What you want at the first appointment and what you do not, how a flow meter works and how to read the trace, what the flow number really tells you about obstruction, the medical therapy trials worth quoting, the surgical trade-off between keeping ejaculation and how long the operation lasts, the reoperation rates that settle it, and the man in chronic retention where the question is when, not whether.

What drives management before any grading, how to answer on the AAST scale and what the 2025 revision changed, what you are actually trying to achieve when you open a bleeding kidney, ureteric injury and its damage-control option, the pelvic fracture patterns that should make you look at the bladder, and the urethral and genital injuries that turn up in the viva as much as the paper.