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100+ Free RCPSC Urology Practice Questions

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2026 Statistics

Key Facts: RCPSC Urology Exam

2 MCQ papers

Written component is Paper 1 and Paper 2, each ~100 single-best-answer questions

RCPSC - Format of the Examination in Urology

3 hours per paper

Each written MCQ paper is 3 hours, for 6 hours of written testing

RCPSC - Format of the Examination in Urology

70%

Pass score required on the written component

RCPSC - Format of the Examination in Urology

Decoupled

Passing the written but not the applied does not require retaking the written

RCPSC - Format of the Examination in Urology

C$5,130

2026 comprehensive exam fee covering both components

RCPSC - Assessment and exam fees 2026

C$850

Assessment of training/eligibility fee

RCPSC - Assessment and exam fees 2026

100

Free original single-best-answer practice questions here

OpenExamPrep

The Royal College Certification Examination in Urology is Canada's national certifying exam for specialist Urologists, administered by the Royal College of Physicians and Surgeons of Canada. The written component has two single-best-answer MCQ papers (~100 questions each, 3 hours per paper). The pass score is 70% for the written component. 2026 registration is C$5,130 for the comprehensive exam (both components) or C$2,565 each component separately, plus a C$850 assessment fee. This 100-question bank provides original single-best-answer practice across the official blueprint, built on CUA and standard international guidelines.

Sample RCPSC Urology Practice Questions

Try these sample questions to test your RCPSC Urology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man presents with a 2.5 cm solid, enhancing renal mass in the lower pole of the right kidney. His biopsy reveals clear cell renal cell carcinoma (ccRCC), ISUP grade 2. He has no lymphadenopathy or distant metastasis. His baseline eGFR is 82 mL/min/1.73m². According to the Canadian Urological Association (CUA) guidelines, what is the preferred management?
A.Partial nephrectomy
B.Radical nephrectomy
C.Active surveillance
D.Percutaneous cryoablation
Explanation: For a clinical T1a renal mass (< 4 cm) where technically feasible, partial nephrectomy (PN) is the gold standard of treatment because it preserves renal function and decreases long-term cardiovascular mortality compared to radical nephrectomy. Active surveillance is reserved for patients with significant comorbidities, limited life expectancy, or very small masses (< 2 cm). Percutaneous ablation is an option for T1a masses but carries a slightly higher local recurrence rate and is generally reserved for patients who are poor surgical candidates.
2A 71-year-old man with a history of COPD presents with macroscopic hematuria. Cystoscopy reveals a 3 cm papillary tumor on the bladder dome. He undergoes transurethral resection of bladder tumor (TURBT). The pathology reveals high-grade T1 urothelial carcinoma with muscularis propria present and free of tumor in the specimen. What is the recommended next step in management?
A.Repeat transurethral resection (re-TURBT) within 2-6 weeks
B.Immediate radical cystectomy
C.Induction course of intravesical Bacillus Calmette-Guérin (BCG)
D.Systemic cisplatin-based chemotherapy
Explanation: For high-grade T1 bladder cancer, CUA and international guidelines strongly recommend a repeat TURBT (re-TURBT) within 2-6 weeks of the initial resection. This is to ensure complete staging, as up to 30-50% of patients have residual disease and 10-15% are understaged and actually have muscle-invasive disease (T2). Re-TURBT is critical before initiating intravesical BCG or considering radical cystectomy.
3A 58-year-old healthy man presents with a PSA of 6.2 ng/mL, confirmed on repeat testing. Digital rectal exam (DRE) reveals a normal-feeling prostate. A transrectal ultrasound-guided prostate biopsy reveals adenocarcinoma in 3 out of 12 cores, Gleason score 3+4=7 (ISUP grade group 2), involving less than 50% of any core. Staging bone scan and pelvic CT are negative. What is the most appropriate first-line management option to discuss?
A.Radical prostatectomy or radiation therapy
B.Androgen deprivation therapy (ADT) monotherapy
C.Active surveillance
D.High-intensity focused ultrasound (HIFU)
Explanation: For intermediate-risk prostate cancer (PSA 10-20 ng/mL, Gleason 7, or clinical stage T2b), definitive local therapy via radical prostatectomy or external beam radiotherapy/brachytherapy is standard. Active surveillance can be offered to highly selected favorable intermediate-risk patients (e.g., low volume Gleason 3+4=7), but definitive treatment is the standard recommendation for most intermediate-risk patients. ADT monotherapy is only indicated for advanced/metastatic disease or palliative intent.
4A 28-year-old man presents with a painless right testicular mass. Ultrasound shows a 3.5 cm heterogeneous intratesticular mass. AFP is normal, beta-hCG is 24 IU/L, and LDH is mildly elevated. He undergoes a right radical inguinal orchiectomy. Pathology confirms a pure seminoma. What is the most likely reason his beta-hCG is elevated?
A.Seminomas can contain syncytiotrophoblastic giant cells that secrete beta-hCG
B.The presence of occult embryonal carcinoma components
C.The patient has underlying hypogonadism causing cross-reactivity with LH
D.Pure seminomas do not secrete beta-hCG; the pathology diagnosis must be incorrect
Explanation: Up to 15-20% of pure seminomas can have syncytiotrophoblastic giant cells, which secrete beta-hCG. An elevated beta-hCG in the presence of pure seminoma pathology does not change the diagnosis to non-seminomatous germ cell tumor (NSGCT), provided the AFP is completely normal. Any elevation of AFP, however, immediately classifies the tumor as an NSGCT regardless of the pathology.
5A 68-year-old woman is found to have a 4.5 cm solid, enhancing mass in the left renal pelvis on CT urography. Urine cytology is positive for high-grade urothelial cells. Staging chest/abdomen/pelvis CT shows no evidence of metastasis. What is the standard surgical treatment for this patient?
A.Radical nephroureterectomy with bladder cuff excision
B.Radical nephrectomy only
C.Partial ureterectomy with ureteroureterostomy
D.Segmental resection of the renal pelvis
Explanation: The standard surgical treatment for high-grade upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU) with bladder cuff excision. This is because urothelial tumors are highly prone to multifocal recurrence along the entire ipsilateral urinary tract. Removal of the entire ureter and its bladder entry point is necessary to minimize the high rate of recurrence in the distal ureteral stump.
6A 65-year-old man undergoes radical prostatectomy for Gleason score 4+4=8 (ISUP Grade Group 4) adenocarcinoma of the prostate. Pathology shows pT3a, pN0 (12 lymph nodes negative), with a positive surgical margin at the apex of 1.5 mm. His first postoperative PSA at 6 weeks is undetectable (< 0.05 ng/mL). According to CUA guidelines, what is the most appropriate management strategy?
A.Observation with serial PSA monitoring
B.Immediate adjuvant external beam radiation therapy
C.Immediate androgen deprivation therapy (ADT)
D.Adjuvant docetaxel chemotherapy
Explanation: CUA guidelines recommend observation with serial PSA monitoring for patients with adverse pathological features (pT3, positive margins) who achieve an undetectable postoperative PSA. Immediate adjuvant radiation therapy was historically recommended but large randomized trials (RADAR, RAVES, GETUG-AFU 17) demonstrated that early salvage radiotherapy at the first sign of PSA relapse (PSA >= 0.1 or 0.2 ng/mL) achieves equivalent oncological outcomes with significantly less urinary and bowel toxicity.
7A 74-year-old man presents with metastatic castration-resistant prostate cancer (mCRPC). He has bone-only metastases and is asymptomatic. His PSA is rising, and his testosterone is 0.8 nmol/L on LHRH agonist therapy. Which of the following agents has demonstrated a survival benefit and is approved in this setting?
A.Abiraterone acetate plus prednisone
B.Bicalutamide monotherapy
C.Ketoconazole
D.Diethylstilbestrol (DES)
Explanation: For patients with mCRPC, abiraterone acetate (an androgen synthesis inhibitor) combined with low-dose prednisone has been shown to improve overall survival in both chemo-naive (COU-AA-302) and post-docetaxel (COU-AA-301) settings. It works by inhibiting CYP17, blocking extragonadal and intratumoral androgen synthesis. Continuous ADT (castrate level testosterone < 1.7 nmol/L or < 50 ng/dL) must be maintained.
8A 52-year-old woman is found to have a 3.5 cm left adrenal mass during a workup for vague abdominal pain. She has no signs of Cushing's syndrome, virilization, or hypertension. What is the initial laboratory workup required to evaluate this adrenal incidentaloma?
A.1-mg overnight dexamethasone suppression test, fractionated plasma metanephrines, and aldosterone-to-renin ratio (ARR)
B.24-hour urinary free cortisol only
C.Fine needle aspiration (FNA) biopsy of the adrenal mass
D.No lab workup is needed unless the CT scan shows a high Hounsfield unit density
Explanation: Every adrenal incidentaloma requires biochemical evaluation to rule out subclinical hypercortisolism (pheochromocytoma and aldosterone-secreting tumors). This includes a 1-mg overnight dexamethasone suppression test, plasma or 24-hour urinary fractionated metanephrines (to rule out pheochromocytoma), and an aldosterone-to-renin ratio (ARR) if the patient has hypertension or hypokalemia. An adrenal biopsy should never be performed until a pheochromocytoma has been biochemically ruled out, to prevent a life-threatening hypertensive crisis.
9A 62-year-old man presents with macroscopic hematuria. CT urography shows a 6 cm enhancing exophytic mass on the upper pole of the left kidney, with a thrombus extending into the left renal vein, stopping 1 cm proximal to the inferior vena cava (IVC). There is no evidence of distant metastasis. What is the TNM stage and appropriate treatment for this patient?
A.T3a N0 M0; Radical nephrectomy with excision of the vein thrombus
B.T2a N0 M0; Partial nephrectomy
C.T3b N0 M0; Radical nephrectomy with retroperitoneal lymph node dissection
D.T4 N0 M0; Neoadjuvant chemotherapy followed by radical nephrectomy
Explanation: According to the AJCC TNM system, renal cell carcinoma extending into the renal vein or its segmental branches, or into the IVC below the diaphragm, is classified as T3a. Radical nephrectomy with surgical excision of the thrombus is the standard treatment for localized T3a disease and provides good long-term survival in the absence of metastatic disease.
10A 32-year-old man undergoes left radical inguinal orchiectomy for a testicular mass. The pathology shows a mixed germ cell tumor comprising 80% embryonal carcinoma, 10% yolk sac tumor, and 10% teratoma, with lymphovascular invasion identified. Postoperative staging CT scan of the chest, abdomen, and pelvis shows no lymphadenopathy or pulmonary nodules. Postoperative tumor markers (AFP, beta-hCG, LDH) normalize completely. What is the clinical stage and the preferred management options under Canadian guidelines?
A.Stage IB; Active surveillance, 1 cycle of adjuvant BEP chemotherapy, or nerve-sparing RPLND
B.Stage IA; Active surveillance or 3 cycles of BEP chemotherapy
C.Stage IS; Immediate 3 cycles of BEP chemotherapy
D.Stage IIA; Surveillance only
Explanation: A non-seminomatous germ cell tumor (NSGCT) with lymphovascular invasion (LVI), no nodal or distant metastases (N0 M0), and normalized markers (S0) is classified as pT2 N0 M0 S0, which is Stage IB. LVI is the staging criterion that upgrades the primary tumor from pT1 to pT2. Embryonal carcinoma predominance is an independent risk factor for relapse but does not change the TNM stage. CUA guidelines recommend active surveillance as the preferred option for most compliant patients, with 1 cycle of adjuvant BEP chemotherapy or nerve-sparing RPLND as alternatives for patients wishing to minimize recurrence risk.

About the RCPSC Urology Exam

The Royal College Certification Examination in Urology is the national certifying exam for specialist urologists in Canada, administered by the Royal College of Physicians and Surgeons of Canada. It assesses readiness to enter unsupervised specialist practice and consists of a written component (two papers of approximately 100 single-best-answer MCQs each, 3 hours per paper) followed by an applied OSCE component. The pass score is 70% for the written component. Content follows a blueprint covering neoplasms, stones, obstruction, trauma, reconstruction, voiding dysfunction, pediatrics, infertility, and sexual dysfunction. The exam follows Canadian standards of care, emphasizing Canadian Urological Association (CUA) guidelines and standard reference textbooks like Campbell-Walsh-Wein Urology.

Assessment

Two-component exam. Written: Two single-best-answer MCQ papers (each ~100 questions, 3 hours per paper). Applied: structured oral/OSCE component. The written must be passed before the applied.

Time Limit

Written: 6 hours total (3 hours for Paper 1 and 3 hours for Paper 2).

Passing Score

70% passing score on the written component. Decoupled format.

Exam Fee

2026 exam registration: C$5,130 for comprehensive objective exam (both components) or C$2,565 each separately, plus a C$850 assessment fee. All fees in Canadian dollars. (Royal College of Physicians and Surgeons of Canada (RCPSC))

RCPSC Urology Exam Content Outline

20%

Neoplasms (Uro-oncology)

Covers oncology of the adrenal gland, kidney, renal pelvis, ureter, bladder, prostate, testis, penis, and retroperitoneum, including diagnostic imaging, staging, pathology, and multidisciplinary treatment protocols.

30%

Urolithiasis, Obstruction & BPH

Covers etiology, pathophysiology, metabolic evaluation, and medical/surgical management of urinary tract stones. Also covers benign prostatic hyperplasia, bladder outlet obstruction, and urinary retention.

30%

Trauma, Reconstruction, Fistula, Infections & Voiding Dysfunction

Renal and lower urinary tract trauma, genital reconstruction, fistula repairs, urinary tract infections, voiding dysfunction, neurogenic bladder, urinary incontinence, and female pelvic medicine.

20%

Pediatric Urology, Infertility & Sexual Dysfunction

Congenital genitourinary anomalies, vesicoureteral reflux, undescended testes, hypospadias, male factor infertility, erectile dysfunction, hypogonadism, priapism, and ejaculatory disorders.

How to Pass the RCPSC Urology Exam

What You Need to Know

  • Passing score: 70% passing score on the written component. Decoupled format.
  • Assessment: Two-component exam. Written: Two single-best-answer MCQ papers (each ~100 questions, 3 hours per paper). Applied: structured oral/OSCE component. The written must be passed before the applied.
  • Time limit: Written: 6 hours total (3 hours for Paper 1 and 3 hours for Paper 2).
  • Exam fee: 2026 exam registration: C$5,130 for comprehensive objective exam (both components) or C$2,565 each separately, plus a C$850 assessment fee. All fees in Canadian dollars.

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

RCPSC Urology Study Tips from Top Performers

1Familiarize yourself with the latest Canadian Urological Association (CUA) guidelines, particularly for prostate cancer screening, bladder cancer surveillance, stone management, and BPH.
2Understand the TNM staging systems and NCCN/CUA risk stratification for all major urological malignancies (prostate, renal, bladder, testis).
3Review pediatric urology milestones and management algorithms, especially for vesicoureteral reflux, undescended testes, antenatal hydronephrosis, and hypospadias.
4Drill reconstructive and trauma principles (e.g., AAST kidney injury grading, urethral injury management, bladder rupture repair indications).
5Ensure a strong grasp of pharmacology related to voiding dysfunction (anticholinergics, beta-3 agonists, alpha-blockers, 5-ARIs) and erectile dysfunction.

Frequently Asked Questions

How many questions are on the Royal College Urology written exam?

The written component consists of two papers, each containing approximately 100 multiple-choice questions (single-best-answer format). Each paper is 3 hours long, for a total of 6 hours of testing.

What is the passing score for the Royal College Urology exam?

The passing score for the written component is 70%. The exam utilizes a decoupled format, meaning that candidates who pass the written component but fail the applied component do not need to retake the written component in subsequent attempts.

Does the Urology exam include an oral component?

Yes, it is a two-component exam. The written component (MCQ) is administered first. Candidates who pass the written component are invited to the applied component, which consists of structured oral/OSCE stations.

How much does the RCPSC Urology certification exam cost?

For 2026, the registration fee is C$5,130 for the comprehensive objective exam (both components) or C$2,565 for each component registered separately. There is also a separate non-refundable assessment fee of C$850. All values are in Canadian dollars.

What guidelines should I focus on for the exam?

The exam emphasizes Canadian standards of care. Candidates should be thoroughly familiar with the Canadian Urological Association (CUA) guidelines and consensus statements, alongside standard reference textbooks such as Campbell-Walsh-Wein Urology.