2022 UPDATE: Canadian Urological AssociationCanadian Urologic Oncology Group guideline: Metastatic castration-naive and castration-sensitive prostate cancer

Question 1

In Canada, what is the mainstay of treatment for de novo metastatic prostate cancer (PCa)?

A. Immunotherapy
B. Chemotherapy
C. Androgen Deprivation Therapy (ADT)
D. Radiation Therapy

Answer 1

C. Androgen Deprivation Therapy (ADT)
Explanation: ADT, either surgical or medical castration, is initially effective in almost all patients with de novo metastatic PCa. However, progression is inevitable, resulting in a disease state called metastatic castration-resistant prostate cancer (mCRPC).

Question 2

What is the median overall survival (OS) for men with metastatic PCa?

A. 1-2 years
B. 3-4 years
C. 5-6 years
D. 7-8 years

Answer 2

B. 3-4 years
Explanation: Men with metastatic PCa have a poor prognosis, with an estimated median overall survival (OS) of approximately 3–4 years.

Question 3

For patients with newly diagnosed PCa, staging should be performed for men with any high-risk features. Which of the following is NOT considered a high-risk feature?

A. PSA >20 ng/mL
B. Gleason score >7
C. Clinical stage T2
D. Clinical stage T3 or greater

Answer 3

C. Clinical stage T2
Explanation: High-risk features for PCa include PSA >20 ng/mL, Gleason score >7, and clinical stage T3 or greater.

Question 4

Which imaging method improves the sensitivity and specificity of conventional imaging for PCa staging?

A. MRI
B. Ultrasound
C. PSMA-targeted PET/CT
D. X-Ray

Answer 4

C. PSMA-targeted PET/CT
Explanation: Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET)/CT improves the sensitivity and specificity of conventional imaging for PCa staging.

Question 5

How does the CHAARTED trial define high-volume disease in mCNPC/mCSPC patients?

A. Presence of visceral metastases or ≥4 bone lesions with ≥1 beyond the vertebral bodies and pelvis
B. Presence of visceral metastases or ≥3 bone lesions with ≥1 beyond the vertebral bodies and pelvis
C. Presence of visceral metastases or ≥2 bone lesions with ≥1 beyond the vertebral bodies and pelvis
D. Presence of visceral metastases or ≥1 bone lesion with ≥1 beyond the vertebral bodies and pelvis

Answer 5

A. Presence of visceral metastases or ≥4 bone lesions with ≥1 beyond the vertebral bodies and pelvis
Explanation: The CHAARTED trial classified PCa based on volume of disease. High-volume was defined by the presence of visceral metastases or ≥4 bone lesions with ≥1 beyond the vertebral bodies and pelvis.

Question 6

Which of the following is the most common site of visceral metastases in patients with high-risk prostate cancer?

A. Liver
B. Kidney
C. Lung
D. Spleen

Answer 6

C. Lung
Explanation: In patients with high-risk disease, CT imaging of the chest may be considered, as lung metastases are the most common site of visceral metastases.

Question 7

According to the LATITUDE trial, high-risk patients are defined based on what criteria?

A. Visceral metastases, ≥3 bony metastases, or Gleason score ≥8; high risk was defined as having two or more of these criteria
B. Visceral metastases, ≥4 bony metastases, or Gleason score ≥7; high risk was defined as having two or more of these criteria
C. Visceral metastases, ≥2 bony metastases, or Gleason score ≥9; high risk was defined as having two or more of these criteria
D. Visceral metastases, ≥1 bony metastases, or Gleason score ≥10; high risk was defined as having two or more of these criteria

Answer 7

A. Visceral metastases, ≥3 bony metastases, or Gleason score ≥8; high risk was defined as having two or more of these criteria
Explanation: The LATITUDE trial classified high-risk patients based on three different criteria: visceral metastases, ≥3 bony metastases, or Gleason score ≥8; high risk was defined as having two or more of these criteria.

Question 8

In what scenario is intermittent androgen suppression (IAS) recommended?

A. In all patients with mCNPC
B. Only as an exception in select patients with close follow-up
C. In all patients with metastatic prostate cancer
D. Only in patients with low-volume disease

Answer 8

B. Only as an exception in select patients with close follow-up
Explanation: Continuous ADT should be used in mCNPC and IAS only used as an exception in select patients with close follow-up.

Question 9

What therapeutic intervention should be considered for patients with low-volume metastatic disease burden of prostate cancer?

A. Chemotherapy
B. External Beam Radiation to the prostate
C. Radical Prostatectomy
D. Immunotherapy

Answer 9

B. External Beam Radiation to the prostate
Explanation: Patients with low-volume metastatic disease burden of prostate cancer should be considered for external beam radiation to the prostate.

Question 10

What is the recommendation for performing radical prostatectomy in mCNPC?

A. It should only be performed in a clinical trial setting
B. It should be performed in all patients with mCNPC
C. It should be performed in patients with high-volume disease
D. It should not be performed at all

Answer 10

A. It should only be performed in a clinical trial setting
Explanation: Currently, there is limited evidence showing the benefit of radical prostatectomy in mCNPC. Until the results of ongoing trials clarify the impact of radical prostatectomy in mCNPC, and more importantly, which patients would benefit most, surgery of the primary is not recommended in patients with mPCa.

Question 11

In the HORRAD and STAMPEDE trials, which group of patients seemed to benefit most from external beam radiation therapy (EBRT)?

A. All patients with mCNPC
B. Patients with high-volume disease
C. Patients with low-volume disease
D. Patients with mCRPC

Answer 11

C. Patients with low-volume disease
Explanation: Although both trials showed a lack of benefit of EBRT in unselected men in mCNPC, both HORRAD and STAMPEDE reveal the benefits of local therapy in those with low-burden disease.

Question 12

What adverse events are associated with Androgen Deprivation Therapy (ADT)?

A. Increased risk of cardiovascular events
B. Increased risk of bone fractures
C. Increased risk of lymphoma
D. Increased risk of kidney disease

Answer 12

A. Increased risk of cardiovascular events
Explanation: ADT is associated with side effects and may increase the risk of cardiovascular events, but the evidence has been contradictory.

Question 13

What therapeutic intervention was compared to Androgen Deprivation Therapy (ADT) alone in the HORRAD and STAMPEDE trials?

A. Immunotherapy
B. External Beam Radiation Therapy (EBRT) of the prostate
C. Radical Prostatectomy
D. Chemotherapy

Answer 13

B. External Beam Radiation Therapy (EBRT) of the prostate
Explanation: In the HORRAD and STAMPEDE trials, External Beam Radiation Therapy (EBRT) of the prostate with ADT was compared to ADT alone.

Question 14

Which trial is testing Radical prostatectomy in Men with Prostate Cancer and oligometastases to the Bone in a randomized controlled feasibility trial?

A. G-RAMPP/AUO-AP-75/13
B. SWOG1802
C. IP2ATLANTA
D. TRoMBONE

Answer 14

D. TRoMBONE
Explanation: The TRoMBONE trial is testing Radical prostatectomy in Men with Prostate Cancer and oligometastases to the Bone in a randomized controlled feasibility trial.

Question 15

What did the STOPCAP meta-analysis conclude about External Beam Radiation Therapy (EBRT) for men with fewer than five bone metastases?

A. There was no improvement in survival
B. There was a 7% improvement in three-year survival
C. There was a decrease in survival
D. The results were inconclusive

Answer 15

B. There was a 7% improvement in three-year survival
Explanation: The STOPCAP meta-analysis combining data from the HORRAD and STAMPEDE trials confirmed the benefits of EBRT in men with fewer than five bone metastases, showing a 7% improvement in three-year survival.

Question 16

How does androgen receptor signaling contribute to the progression of Prostate Cancer (PCa)?

A. It inhibits the growth of cancer cells
B. It promotes the growth of cancer cells
C. It has no effect on the growth of cancer cells
D. It only affects cancer cells in the late stages of the disease

Answer 16

B. It promotes the growth of cancer cells
Explanation: Androgen receptor signaling plays a key role in the progression of PCa, and thus, de novo mCNPC remains highly driven by testosterone.

Question 17

Docetaxel, a chemotherapeutic agent, is often used in the treatment of metastatic castration-naive and castration-sensitive prostate cancer (mCNPC/mCSPC). How does docetaxel work?

A) It inhibits the production of prostate specific antigen (PSA)
B) It binds to tubulin and inhibits mitosis and tumor proliferation
C) It suppresses the immune system, reducing the body’s response to cancer cells
D) It boosts the production of testosterone, which inhibits the growth of prostate cancer cells

Answer 17

B) It binds to tubulin and inhibits mitosis and tumor proliferation
Explanation: Docetaxel is a taxane derivative that works by binding to tubulin, a protein that forms the microtubules necessary for cell division. By doing this, docetaxel inhibits mitosis and the proliferation of tumor cells.

Question 18

According to the CHAARTED trial, which group of patients with mCNPC/mCSPC showed a survival benefit from the combination of docetaxel and androgen deprivation therapy (ADT)?

A) Patients with high-volume metastases
B) Patients with low-volume metastases
C) Both groups showed a significant survival benefit
D) Neither group showed a significant survival benefit

Answer 18

A) Patients with high-volume metastases
Explanation: The CHAARTED trial showed that the combination of docetaxel and ADT provided a survival benefit for patients with high-volume metastases, defined as the presence of visceral metastases or four or more bone lesions with at least one beyond the vertebral bodies and pelvis. However, this survival benefit was not observed in patients with low-volume metastases.

Question 19

According to the Canadian Urological Association guidelines, for which patients is docetaxel plus ADT strongly recommended?

A) Patients with mCNPC/mCSPC, good performance status, and high-volume metastatic disease
B) Patients with mCNPC/mCSPC, good performance status, and low-volume metastatic disease
C) Patients with mCNPC/mCSPC, poor performance status, and high-volume metastatic disease
D) Patients with mCNPC/mCSPC, poor performance status, and low-volume metastatic disease

Answer 19

A) Patients with mCNPC/mCSPC, good performance status, and high-volume metastatic disease
Explanation: The guidelines strongly recommend docetaxel plus ADT for patients with metastatic castration-naive and castration-sensitive prostate cancer (mCNPC/mCSPC), good performance status, and high-volume metastatic disease. For patients with low-volume disease, the recommendation is weaker.

Question 20

What was the main difference between the patient cohorts in the CHAARTED and GETUG-AFU15 trials that evaluated the use of docetaxel in mCNPC/mCSPC?

A) The CHAARTED trial included a higher proportion of patients with high-volume metastases compared to the GETUG-AFU15 trial
B) The GETUG-AFU15 trial included a higher proportion of patients with high-volume metastases compared to the CHAARTED trial
C) The CHAARTED trial exclusively included patients with low-volume metastases, whereas the GETUG-AFU15 trial included both high and low-volume metastases
D) The GETUG-AFU15 trial exclusively included patients with low-volume metastases, whereas the CHAARTED trial included both high and low-volume metastases

Answer 20

A) The CHAARTED trial included a higher proportion of patients with high-volume metastases compared to the GETUG-AFU15 trial
Explanation: The main difference between the patient cohorts in the two trials was the burden of disease. While 65% of patients in the CHAARTED trial had high-volume metastases, only 48% of patients in the docetaxel arm of the GETUG-AFU15 trial had high-volume disease.

Question 21

The STAMPEDE trial also assessed the impact of docetaxel in mCNPC/mCSPC. What was unique about the patient population in this trial compared to the CHAARTED and GETUG-AFU15 trials?

A) The STAMPEDE trial included high-risk non-metastatic prostate cancer patients
B) The STAMPEDE trial only included low-risk metastatic prostate cancer patients
C) The STAMPEDE trial did not include any patients with metastatic disease
D) The STAMPEDE trial only included patients with high-volume metastatic disease

Answer 21

A) The STAMPEDE trial included high-risk non-metastatic prostate cancer patients
Explanation: Unlike the CHAARTED and GETUG-AFU15 trials, the STAMPEDE trial included patients with high-risk non-metastatic prostate cancer. This expanded patient population allowed the trial to assess the impact of docetaxel in a broader range of prostate cancer patients.

Question 22

According to the Canadian Urological Association guidelines, what is the level of recommendation for docetaxel plus ADT in patients with mCNPC/mCSPC, good performance status, and low-volume metastatic disease?

A) Level of evidence 1, Strong recommendation
B) Level of evidence 2, Weak recommendation
C) Level of evidence 3, No recommendation
D) Level of evidence 4, Strong recommendation against

Answer 22

B) Level of evidence 2, Weak recommendation
Explanation: While docetaxel plus ADT is strongly recommended for patients with high-volume metastatic disease, the recommendation is weaker (Level of evidence 2, Weak recommendation) for patients with low-volume disease.

Question 23

Which of the following trials demonstrated no survival difference between the ADT plus docetaxel group and the ADT alone group in patients with mCNPC/mCSPC?

A) CHAARTED
B) STAMPEDE
C) GETUG-AFU 15
D) None of the above

Answer 23

C) GETUG-AFU 15
Explanation: The GETUG-AFU 15 trial showed no survival difference between the groups (58.9 months in the combined group vs. 54.2 months in the ADT alone group). This is in contrast to the CHAARTED and STAMPEDE trials, which showed a survival benefit in certain patient groups treated with ADT plus docetaxel.

Question 24

According to a recent meta-analysis of CHAARTED, GETUG-AFU15, and STAMPEDE, what is the absolute improvement in four-year survival with the addition of docetaxel to ADT for patients with mCNPC/mCSPC?

A) 2%
B) 4%
C) 9%
D) 15%

Answer 24

C) 9%
Explanation: A recent meta-analysis of CHAARTED, GETUG-AFU15, and STAMPEDE showed that the addition of docetaxel to ADT for patients with mCNPC/mCSPC provides an absolute improvement in four-year survival of 9%.

Question 25

In the STAMPEDE trial, what were the high-risk features defined as for locally advanced prostate cancer?

A) T1/2, Gleason score of 6-7, and PSA <20 ng/mL
B) T3/4, Gleason score of 8–10, and PSA ≥40 ng/mL
C) T2/3, Gleason score of 7-9, and PSA ≥20 ng/mL
D) T3/4, Gleason score of 7–9, and PSA <40 ng/mL

Answer 25

B) T3/4, Gleason score of 8–10, and PSA ≥40 ng/mL
Explanation: In the STAMPEDE trial, high-risk features for locally advanced prostate cancer were defined as at least two of the following: T3/4, Gleason score of 8–10, and PSA ≥40 ng/mL.

Question 26

According to the Canadian Urological Association guidelines, patients with what characteristics can be considered for docetaxel chemotherapy?

A) At least two of: Gleason score of 8–10, visceral metastases, and three or more bone metastases
B) At least one of: Gleason score of 8–10, visceral metastases, and three or more bone metastases
C) All of: Gleason score of 8–10, visceral metastases, and three or more bone metastases
D) None of the above

Answer 26

A) At least two of: Gleason score of 8–10, visceral metastases, and three or more bone metastases
Explanation: According to the guidelines, patients with at least two of the following high-risk features: Gleason score of 8–10, visceral metastases, and three or more bone metastases, can be considered for docetaxel chemotherapy.

Question 27

How does abiraterone acetate function as part of prostate cancer treatment?
A) It binds to the androgen receptor, blocking its activation
B) It inhibits CYP17A1, a key enzyme in androgen biosynthesis
C) It promotes apoptosis in prostate cancer cells
D) It inhibits angiogenesis in prostate tumors

Answer 27

B) It inhibits CYP17A1, a key enzyme in androgen biosynthesis
Explanation: Abiraterone acetate is a prodrug of abiraterone, which inhibits CYP17A1. This enzyme is critical in the production of androgens, which can fuel the growth of prostate cancer. By inhibiting CYP17A1, abiraterone acetate disrupts androgen biosynthesis, thereby helping to control the progression of the disease.

Question 28

According to the LATITUDE trial, which group of patients showed a significant improvement in overall survival when treated with abiraterone acetate plus prednisone and ADT?
A) Patients with high-volume disease
B) Patients with low-volume disease
C) Both high-volume and low-volume disease patients
D) Neither high-volume nor low-volume disease patients

Answer 28

A) Patients with high-volume disease
Explanation: The LATITUDE trial demonstrated that patients with high-volume disease (i.e., at least two of three high-risk features) had a significant improvement in overall survival when treated with abiraterone acetate plus prednisone and ADT. However, there was no significant survival benefit for patients with low-volume disease.

Question 29

In the STAMPEDE trial, which group of patients showed a significant improvement in overall survival when treated with abiraterone acetate plus prednisolone and ADT?
A) Patients with metastatic disease
B) Patients with non-metastatic high-risk prostate cancer
C) Both metastatic and non-metastatic high-risk prostate cancer patients
D) Neither metastatic nor non-metastatic high-risk prostate cancer patients

Answer 29

A) Patients with metastatic disease
Explanation: The STAMPEDE trial demonstrated a significant improvement in overall survival for patients with metastatic disease when treated with abiraterone acetate plus prednisolone and ADT. However, no significant survival benefit was observed for patients with non-metastatic high-risk prostate cancer.

Question 30

Based on an unplanned, post-hoc analysis of the STAMPEDE trial, was the addition of abiraterone acetate and prednisone to ADT beneficial for men with mCNPC irrespective of stratification for “risk” or “volume”?
A) Yes, according to both CHAARTED and LATITUDE criteria
B) No, according to both CHAARTED and LATITUDE criteria
C) Yes, according to CHAARTED criteria but not LATITUDE criteria
D) Yes, according to LATITUDE criteria but not CHAARTED criteria

Answer 30

A) Yes, according to both CHAARTED and LATITUDE criteria
Explanation: An unplanned, post-hoc analysis of the STAMPEDE trial suggested that the addition of abiraterone acetate and prednisone to ADT provided a survival benefit for men with mCNPC, regardless of whether they were classified as “high-risk” or “low-risk” according to LATITUDE criteria, or “high-volume” or “low-volume” according to CHAARTED criteria. However, this was a retrospective analysis, and the results should therefore be considered hypothesis-generating.

Question 31

According to the Canadian Urological Association guidelines, for which patients is abiraterone acetate plus prednisone and ADT strongly recommended?
A) Patients with mCNPC with at least two of three high-risk features
B) Patients with low-volume mCNPC
C) Both patients with mCNPC with at least two of three high-risk features and low-volume mCNPC patients
D) Neither patients with mCNPC with at least two of three high-risk features nor low-volume mCNPC patients

Answer 31

A) Patients with mCNPC with at least two of three high-risk features
Explanation: The Canadian Urological Association guidelines strongly recommend abiraterone acetate plus prednisone and ADT for patients with mCNPC with at least two of the three high-risk features (Gleason score of ≥8, presence of three or more lesions on bone scan, or presence of measurable visceral metastasis). For patients with low-volume mCNPC, the recommendation is weaker.

Question 32

What is the recommended treatment option for patients with mCNPC/mCSPC regardless of volume of disease?

A) Docetaxel
B) Enzalutamide (160 mg/day)
C) Placebo
D) Bicalutamide

Answer 32

B) Enzalutamide (160 mg/day)

Explanation: The 2022 Canadian Urological Association-Canadian Urologic Oncology Group guideline recommends enzalutamide (160 mg/day) as a treatment option for patients with mCNPC/mCSPC regardless of the volume of disease.

Question 33

How should enzalutamide be used in combination with docetaxel to treat patients with mCNPC/mCSPC?

A) Concurrent use
B) Sequential use
C) Not to be used
D) Either concurrent or sequential use

Answer 33

C) Not to be used

Explanation: The guideline strongly recommends that enzalutamide should not be used in combination (concurrent use) with docetaxel to treat patients with mCNPC/mCSPC. However, enzalutamide may be considered in patients with mCSPC previously treated with docetaxel chemotherapy (sequential use).

Question 34

What is the mechanism of action of enzalutamide?

A) It promotes the AR nuclear translocation and interaction with DNA.
B) It inhibits the AR nuclear translocation and interaction with DNA.
C) It increases the production of androgens.
D) It promotes the binding of androgens to their receptors.

Answer 34

B) It inhibits the AR nuclear translocation and interaction with DNA.

Explanation: Enzalutamide acts by binding to the androgen receptor (AR) and inhibiting the AR nuclear translocation and interaction with DNA. This leads to the suppression of the AR.

Question 35

What was the primary endpoint of the ARCHES trial?

A) Overall survival (OS)
B) Radiologic progression-free survival (rPFS)
C) Time to progression
D) Adverse events

Answer 35

B) Radiologic progression-free survival (rPFS)

Explanation: The primary endpoint of the ARCHES trial, which studied the use of enzalutamide in patients with mCNPC/mCSPC, was radiologic progression-free survival (rPFS). This was defined as the time from randomization to the first objective evidence of radiographic disease progression or death.

Question 36

What was the overall survival benefit in the ENZAMET trial for the group without planned early docetaxel use?

A) No survival benefit
B) HR 0.67
C) HR 0.8
D) HR 0.9

Answer 36

C) HR 0.8

Explanation: In the ENZAMET trial, a subgroup analysis showed that the benefits of enzalutamide on overall survival appeared only in the group without planned early docetaxel use, with a hazard ratio (HR) of 0.8.

Question 37

What was the main conclusion regarding the concurrent use of docetaxel and enzalutamide in mCNPC/mCSPC from the ENZAMET trial?

A) This combination should be used.
B) This combination should not be used.
C) There was no conclusion made.
D) The data is not sufficient to make a conclusion.

Answer 37

B) This combination should not be used.

Explanation: The results of the ENZAMET trial suggested that the combination of docetaxel and enzalutamide should not be used in mCNPC/mCSPC until further evidence is shown for its benefits.

Question 38

What is the therapeutic function of Apalutamide in the treatment of mCNPC/mCSPC?

a) It inhibits the DNA binding of the AR by promoting its nuclear translocation.

b) It enhances the DNA binding of the AR by promoting its nuclear translocation.

c) It inhibits the DNA binding of the AR by preventing its nuclear translocation.

d) It enhances the AR’s effect by promoting its binding to the DNA.

Answer 38

c) It inhibits the DNA binding of the AR by preventing its nuclear translocation.

Explanation: Apalutamide acts by inhibiting the androgen receptor (AR) and preventing its nuclear translocation and DNA binding. This action is important in the treatment of metastatic castration-naive and castration-sensitive prostate cancer.

Question 39

In the TITAN trial, what percentage of patients had low-volume disease?

a) 10.7%

b) 37.3%

c) 52.2%

d) 68.2%

Answer 39

b) 37.3%

Explanation: The TITAN trial reported that 37.3% of the patients had low-volume disease.

Question 40

The rPFS at 24 months in the TITAN trial for the apalutamide group was:

a) 47.5%

b) 68.2%

c) 35%

d) 52.2%

Answer 40

b) 68.2%

Explanation: The TITAN trial found that the radiographic progression-free survival (rPFS) at 24 months was 68.2% in the apalutamide group.

Question 41

In the TITAN trial, what was the risk reduction in death observed with the use of apalutamide?

a) 35%

b) 52.2%

c) 68.2%

d) 47.5%

Answer 41

a) 35%

Explanation: The final analysis of Overall Survival (OS) showed that apalutamide reduced the risk of death by 35%.

Question 42

The benefit of apalutamide in rPFS and OS was seen regardless of:

a) Disease burden and timing of metastases.

b) Previous chemotherapy use.

c) Volume of disease.

d) All of the above.

Answer 42

According to the TITAN trial, apalutamide shows benefits in radiographic progression-free survival (rPFS) and overall survival (OS), regardless of disease burden, timing of metastases (de novo vs. metachronous), and prior chemotherapy use.

Question 43

What was the dosage of apalutamide used in the TITAN trial?

a) 100 mg once daily

b) 240 mg once daily

c) 480 mg once daily

d) 720 mg once daily

Answer 43

b) 240 mg once daily

Explanation: The TITAN trial used a dosage of 240 mg of apalutamide once daily.

Question 44

What percentage of patients in the TITAN trial received previous docetaxel therapy?

a) 10.7%

b) 37.3%

c) 52.2%

d) 68.2%

Answer 44

a) 10.7%

Explanation: The TITAN trial reported that 10.7% of the patients had received previous docetaxel therapy.

Question 45

Which of the following is true about the use of abiraterone acetate plus prednisone in combination with ADT and docetaxel for treating patients with mCNPC/mCSPC?
a) It is a treatment option only for high-volume disease.
b) It is a treatment option for both high-volume and low-volume disease.
c) It is a treatment option only for low-volume disease.
d) None of the above.

Answer 45

b) It is a treatment option for both high-volume and low-volume disease.
Explanation:
According to the 2022 Canadian Urological Association and Canadian Urologic Oncology Group guidelines, abiraterone acetate plus prednisone in combination with ADT and docetaxel is a treatment option for patients with mCNPC/mCSPC in high-volume disease. Moreover, this combination may also be considered for patients with mCNPC/mCSPC with low-volume disease.

Question 46

What are the potential risks of adding abiraterone to SOC in treating patients with mCNPC/mCSPC?
a) It significantly increases grade 3 adverse events.
b) It increases the risk of hypertension.
c) It does not increase any risks.
d) It decreases the risk of neutropenia.

Answer 46

b) It increases the risk of hypertension.
Explanation:
The addition of abiraterone to SOC (Standard of Care) increases the risk of hypertension from 13% to 22%. However, it does not significantly increase grade 3 adverse events or other severe adverse events such as neutropenia or fatigue.

Question 47

What was the significant finding of the ARASENS trial regarding the use of darolutamide in combination with ADT and docetaxel?
a) It decreased the overall survival rate.
b) It increased the risk of death.
c) It improved the overall survival rate.
d) It resulted in a higher incidence of adverse events.

Answer 47

c) It improved the overall survival rate.
Explanation:
The ARASENS trial found that a significant improvement in overall survival was observed in those receiving darolutamide; the risk of death was 32.5% lower in the darolutamide group than in the placebo group.

Question 48

How does the use of abiraterone acetate plus prednisone in combination with ADT and docetaxel affect patients with low-volume mCNPC/mCSPC disease?
a) It significantly improves the overall survival.
b) It reduces the relative risk of radiographic progression or death.
c) It increases the risk of adverse events.
d) It has no significant effects.

Answer 48

b) It reduces the relative risk of radiographic progression or death.
Explanation:
In patients with low-volume disease, the addition of abiraterone to SOC reduced the relative risk of radiographic progression or death, however, overall survival benefits were not found due to lack of maturity of the data.

Question 49

What is the effect of adding darolutamide to docetaxel in the treatment of mCNPC/mCSPC?
a) It increases the risk of adverse events such as neutropenia or fatigue.
b) It decreases the risk of rash and hypertension.
c) It slightly increases the rate of rash and hypertension.
d) It has no effect on the rate of rash and hypertension.

Answer 49

c) It slightly increases the rate of rash and hypertension.
Explanation:
The addition of darolutamide to docetaxel slightly increased the rate of rash (16.6% vs. 13.5%) and hypertension (13.7% vs. 9.2%). However, it did not increase adverse events such as neutropenia or fatigue.

Question 50

Question: What is the recommended daily dose of vitamin D for patients with mCNPC/mCSPC treated with ADT?
a. 800 IU
b. 1000 IU
c. 1200 IU
d. 1500 IU

Answer 50

b. 1000 IU

Explanation: According to the guidelines, patients with mCNPC/mCSPC treated with ADT should be encouraged to take 1000 IU of vitamin D daily.

Question 51

Which of the following is NOT a recommended lifestyle change for patients with mCNPC/mCSPC treated with ADT?
a. Smoking cessation
b. Reduction in alcohol and caffeine intake
c. Increased weight-bearing exercises
d. Increased consumption of red meat

Answer 51

Which of the following is NOT a recommended lifestyle change for patients with mCNPC/mCSPC treated with ADT?
a. Smoking cessation
b. Reduction in alcohol and caffeine intake
c. Increased weight-bearing exercises
d. Increased consumption of red meat

Question 52

If a DXA scan shows evidence of osteopenia or osteoporosis in a patient with mCNPC/mCSPC treated with ADT, which of the following is NOT a suggested treatment?
a. Zoledronic acid 5 mg once a year
b. Alendronate 70 mg weekly
c. Denosumab 60 mg every six months
d. Ibuprofen 400 mg daily

Answer 52

d. Ibuprofen 400 mg daily

Explanation: The guidelines mention the use of zoledronic acid, alendronate, and denosumab for the treatment of osteopenia or osteoporosis in these patients. Ibuprofen is not mentioned as a treatment option.

Question 53

What is the recommended frequency of DXA scans for patients with mCNPC/mCSPC treated with ADT?
a. Every six months
b. Annually
c. Every two years
d. Every five years

Answer 53

c. Every two years

Explanation: The guidelines recommend that DXA scans should be performed at least every two years for these patients.

Question 54

Within the first year of ADT, patients can lose up to what percentage of their bone mineral density?
a. 5%
b. 10%
c. 15%
d. 20%

Answer 54

b. 10%

Explanation: According to the guidelines, within one year, patients on ADT can lose up to 10% of their bone mineral density.

Question 55

What is the recommended daily total intake of calcium for patients with mCNPC/mCSPC treated with ADT?
a. 500-700 mg
b. 800-1000 mg
c. 1000-1200 mg
d. 1500-2000 mg

Answer 55

What is the recommended daily total intake of calcium for patients with mCNPC/mCSPC treated with ADT?
a. 500-700 mg
b. 800-1000 mg
c. 1000-1200 mg
d. 1500-2000 mg

Question 56

Which bone-targeted therapy is NOT recommended for patients with mCNPC/mCSPC and evidence of osteopenia or osteoporosis?
a. Zoledronic acid 5 mg once a year
b. Alendronate 70 mg weekly
c. Denosumab 60 mg every six months
d. Risedronate 35 mg weekly

Answer 56

d. Risedronate 35 mg weekly

Explanation: The guidelines mention the use of zoledronic acid, alendronate, and denosumab for the treatment of osteopenia or osteoporosis in these patients. Risedronate is not mentioned as a treatment option.

Question 57

In patients with mCNPC/mCSPC treated with ADT, incidences of clinically significant hypocalcemia and osteonecrosis of the jaw are rare using which therapies?
a. Denosumab or zoledronic acid
b. Alendronate or risedronate
c. Zoledronic acid or alendronate
d. Denosumab or risedronate

Answer 57

a. Denosumab or zoledronic acid

Explanation: The guidelines state that incidences of clinically significant hypocalcemia and osteonecrosis of the jaw are rare using denosumab or zoledronic acid at the recommended doses.

Question 58

What is the T-score range for osteopenia?
a. <-1 and >-2.5
b. <-1.5 and >-2.5
c. <-2 and >-3
d. <-2.5 and >-3.5

Answer 58

a. <-1 and >-2.5

Explanation: The guidelines define osteopenia as having a T-score of <-1 and >-2.5.

Question 59

What tool is recommended for calculating fracture risk in patients with mCNPC initiating ADT?
a. FRAX
b. QFracture
c. Garvan
d. SCORE

Answer 59

a. FRAX

Explanation: The guidelines recommend using the FRAX calculator to assess fracture risk in patients with mCNPC initiating ADT.

Question 60

What is the T-score range for osteoporosis?
a. <-1 and >-2.5
b. <-1.5 and >-2.5
c. <-2 and >-3
d. <-2.5

Answer 60

d. <-2.5

Explanation: According to the guidelines, osteoporosis is defined as having a T-score of <-2.5.

Question 61

Which of the following is NOT a side effect of the recommended bone-targeted therapies (zoledronic acid, alendronate, denosumab) at the recommended doses?
a. Significant hypocalcemia
b. Osteonecrosis of the jaw
c. Acute renal failure
d. Both a and b are potential side effects

Answer 61

c. Acute renal failure

Explanation: The guidelines mention that incidences of clinically significant hypocalcemia and osteonecrosis of the jaw are rare using denosumab or zoledronic acid at the recommended doses. Acute renal failure is not mentioned as a side effect at these doses.

Question 62

According to the guidelines, what is the recommended initial assessment for patients with mCNPC initiating ADT?
a. Dual-energy x-ray absorptiometry (DXA) scan
b. Computed Tomography (CT) scan
c. Magnetic Resonance Imaging (MRI) scan
d. Positron Emission Tomography (PET) scan

Answer 62

a. Dual-energy x-ray absorptiometry (DXA) scan

Explanation: The guidelines recommend that patients with mCNPC initiating ADT should have baseline BMD measured with a DXA scan.

Question 63

What is the primary risk for patients with de novo PCa due to the evolution of combined therapy with ADT?
a. Significant bone loss, osteoporosis, and fragility fractures
b. Development of skeletal-related events (SREs)
c. Development of metastatic castration-resistant prostate cancer (mCRPC)
d. Development of renal impairment

Answer 63

a. Significant bone loss, osteoporosis, and fragility fractures

Explanation: The guidelines state that due to the evolution of combined therapy with ADT to treat mCNPC, the survival of patients with de novo PCa is increasing, and length of time bone is exposed to the effects of ADT is also increasing. As such, these patients are at risk of significant bone loss, osteoporosis, and fragility fractures.

Question 64

How quickly does bone loss occur in patients on ADT?
a. Within the first six months
b. Within the first year
c. Within the first two years
d. Bone loss is gradual and does not occur quickly

Answer 64

b. Within the first year

Explanation: The guidelines state that bone loss occurs quickly while on ADT, and within one year, patients can lose up to 10% of their bone mineral density.

Question 65

In the context of bone-targeted therapy, the doses of zoledronic acid, alendronate, and denosumab mentioned in the guidelines are significantly lower than those needed to prevent what in patients with mCRPC?
a. Significant hypocalcemia
b. Osteonecrosis of the jaw
c. Skeletal-related events (SREs)
d. Acute renal failure

Answer 65

c. Skeletal-related events (SREs)

Explanation: The guidelines mention that the doses of zoledronic acid, alendronate, and denosumab recommended for improving BMD and reducing the risk of fragility fractures are much lower than those needed to prevent SREs in patients with mCRPC.

Question 66

According to the guidelines, what health risk should all patients treated with ADT be assessed for?
a. Fracture risk
b. Risk of developing mCRPC
c. Risk of renal impairment
d. Risk of cardiovascular disease

Answer 66

a. Fracture risk

Explanation: The guidelines state that all patients with mCNPC/mCSPC treated with ADT should be assessed for fracture risk.

Question 67

Which of the following is NOT recommended to patients with mCNPC/mCSPC treated with ADT for bone health?
a. Vitamin D supplementation
b. Calcium supplementation
c. Baseline BMD measurement with DXA
d. Regular intake of high-sodium foods

Answer 67

d. Regular intake of high-sodium foods

Explanation: The guidelines recommend vitamin D supplementation, calcium supplementation, and baseline BMD measurement with DXA. Regular intake of high-sodium foods is not mentioned in the guidelines.

Question 68

What is the recommended dose of alendronate for the treatment of osteopenia or osteoporosis in men with mCNPC/mCSPC treated with ADT?
a. 35 mg weekly
b. 50 mg weekly
c. 70 mg weekly
d. 100 mg weekly

Answer 68

c. 70 mg weekly

Explanation: The guidelines recommend a dose of 70 mg weekly of alendronate for the treatment of osteopenia or osteoporosis in these patients.

Question 69

What term is used to describe a low-burden, asymptomatic distant metastasis in prostate cancer?

a) Polymetastatic
b) Hypermetastatic
c) Oligometastatic
d) Monometastatic

Answer 69

c) Oligometastatic

Explanation: The term “oligometastatic” is used to describe a state of cancer spread that is limited in number and location, often used in the context of prostate cancer.

Question 70

What is the current consensus for the treatment of oligo-metastatic prostate cancer according to the 2022 Canadian Urological Association Guidelines?

a) The use of radiation is generally recommended.
b) Surgery is the first line of treatment.
c) A multidisciplinary approach is required.
d) The use of chemotherapy is always recommended.

Answer 70

c) A multidisciplinary approach is required.

Explanation: The guideline mentions that there is currently limited data with which to provide general recommendations for the treatment of oligo-metastatic disease. However, a multidisciplinary approach would provide the best opportunity to determine optimal management on a case-by-case basis.

Question 71

What is generally suggested for the management of patients with oligo-metastatic prostate cancer based on the 2022 Canadian Urological Association Guidelines?

a) Patient enrollment in ongoing clinical trials is discouraged.
b) Patient enrollment in ongoing clinical trials is considered.
c) All patients should undergo surgery.
d) All patients should receive radiation therapy.

Answer 71

b) Patient enrollment in ongoing clinical trials is considered.

Explanation: The guideline suggests that patient enrollment in ongoing clinical trials should be considered to determine the optimal management of oligo-metastatic prostate cancer.

Question 72

What is the recommended practice for patients with metastatic castration-naive and castration-sensitive prostate cancer (mCNPC/mCSPC)?

A) They should be assessed in a multidisciplinary manner whenever possible.
B) They should be assessed by a single specialist for consistency.
C) They should be assessed by their general practitioner only.
D) They should self-assess their symptoms and report back to their specialist.

Answer 72

A. Patients with mCNPC/mCSPC should be assessed in a multidisciplinary manner whenever possible. This approach can provide a holistic view of the patient’s condition and aid in devising the most effective treatment plan.

Question 73

What factors should be considered when determining the timing of treatment initiation and selecting the optimal systemic therapy for patients with mCNPC/mCSPC?

A) Eligibility of chemotherapy, disease burden, symptoms, and presence of visceral metastases.
B) Patient’s age, patient’s job, and patient’s marital status.
C) Patient’s height, patient’s weight, and patient’s blood type.
D) Patient’s food preference, patient’s exercise routine, and patient’s sleeping patterns.

Answer 73

A. Consideration of factors such as the eligibility of chemotherapy, disease burden, symptoms, and presence of visceral metastases is essential when determining the timing of treatment initiation and selecting the optimal systemic therapy for patients with mCNPC/mCSPC.

Question 74

For patients with low-risk/low-volume mCNPC/mCSPC, in addition to systemic therapy, which treatment should be strongly considered?

A) Radiation therapy to the prostate
B) Major surgery
C) Weekly check-ups
D) Dietary changes

Answer 74

A. For patients with low-risk/low-volume mCNPC/mCSPC, radiation therapy to the prostate should be strongly considered in addition to systemic therapy. This approach can increase the intensity of the treatment and potentially improve the patient’s prognosis.

Question 75

Why should mCNPC/mCSPC patients be considered for inclusion in clinical trials?

A) Because these trials offer free medication.
B) Because it provides an opportunity for patients to contribute to medical research.
C) Because mCNPC/mCSPC continues to be an incurable disease.
D) Because it’s a requirement of most healthcare providers.

Answer 75

C. Since mCNPC/mCSPC continues to be an incurable disease, strong consideration should be given to including patients in clinical trials, as these trials may offer access to cutting-edge treatments and experimental therapies.

Question 76

In recent years, how has the landscape of treatment for mCNPC/mCSPC changed?

A) There has been a significant reduction in available therapies.
B) There has been no change in the available therapies.
C) There has been a significant growth of life-extending therapies.
D) There has been a shift towards non-surgical treatments.

Answer 76

C. The last few years have seen a significant growth of life-extending therapies for prostate cancer patients, changing the landscape of treatment for mCNPC/mCSPC.

Question 77

Answer 77

Figure 1. Summary of treatment for metastatic castration-naive and castration-sensitive prostate cancer. ADT: androgen deprivation therapy; SOC: standard of care,