Ch 150 Prostate Biopsies Flashcards
Prostatic corpora amylacea are calcifications found where?
Between transition and peripheral zone
Which of the following states is TRUE about TRUS of the seminal vesicles?
A) masses in the SV are the most common lesion seen on TRUS of the prostate
B) SV are usually asymmetrical and normally measure <2cm in length in an adult
C) Most cystic masses in the SV are malignant and related to prostate CA
D) A solid mass in the SV is always associated with malignany
E) Solid masses in the SV can be caused by schistosomiasis in endemic regions.
E) Solid masses in the SV can be caused by schistosomiasis in endemic regions.
Calcifications diffusely seen in the prostate on TRUS are:
A) called corpora amylacea
B) always considered abnormal and mandate biopsy
C) considered diagnostic of prostate CA
D) incidental finding usually due to advanced age
E) walls of blood vessels
D) incidental finding usually due to advanced age
hich of the following statements about the seminal vesicle (SV) when imaged by ultrasound is TRUE?
a. The average seminal vesicle is approximately 4.5 to 5.5 cm in length.
b. A unilaterally absent seminal vesicle suggests an undescended testicle on the ipsilateral side.
c. Seminal vesicles are usually asymmetric.
d. The eMaculatory ducts run alongside the seminal vesicles and cannot be visualized on transrectal ultrasound.
e. The seminal vesicles are difficult to image using standard TRUS probes.
a. The average seminal vesicle is approximately 4.5 to 5.5 cm in length.
Which of the following statements concerning ultrasonographic estimates of prostate size/volume is TRUE?
a. Only one formula (prolate ellipse) is acceptable to determine prostate volume.
b. There is a poor correlation between radical prostatectomy specimen weights and volume as measured by TRUS.
c. The mature average prostate is between 20 and 25 g and remains relatively constant until approximately age 50, when the gland enlarges in many men.
d. Prostate cancer is always associated with an increase in overall volume of the prostate.
e. Planimetry with a stepping device should be used for routine prostate volume determinations.
c. The mature average prostate is between 20 and 25 g and remains relatively constant until approximately age 50, when the gland enlarges in many men.
A hypoechoic lesion of the prostate can be caused by all of the following EXCEPT:
a. granulomatous prostatitis.
b. transition zone, benign prostatic hyperplasia nodules.
c. prostate cancer.
d. hematologic malignancies.
e. normal urethra.
d. hematologic malignancies.
Which of the following statements is TRUE about anesthesia for TRUS prostate biopsy?
a. Intrarectal lidocaine gel is as effective as the inMection of lidocaine.
b. It is not necessary even with extended-core biopsies, owing to the small size of the needle.
c. It is best performed using direct inMection of lidocaine into the prostate gland.
d. It is typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe.
e. It is typically performed using digital guidance to ensure that the base of the prostate near the seminal vesicles is infiltrated.
d. It is typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe.
When performing TRUS prostate biopsy:
a. the left lateral decubitus position is most commonly used.
b. the right lateral decubitus position is most commonly used.
c. enemas should not be used before the procedure and may increase the risk of bleeding.
d. intravenous antibiotic prophylaxis is necessary in all patients to prevent urosepsis.
e. the dorsal lithotomy position with the use of stirrups increases the diagnostic accuracy of the prostate biopsies.
a. the left lateral decubitus position is most commonly used.
When performing TRUS prostate biopsy:
a. only hypoechoic lesions should be sampled.
b. sextant biopsy represents the current standard of care for the diagnosis of prostate cancer. c. the transition zone should be included in all initial biopsies because of the high incidence of cancer in this area.
d. a minimum of 12 systematic biopsies is currently recommended.
e. isoechoic lesions are rarely cancerous and should not be sampled unless they are calcified.
d. a minimum of 12 systematic biopsies is currently recommended.
Sextant biopsy - 6 cores
Systematic biopsy - 12 cores
Saturation biopsy - ~18 cores
Which of the following statements is TRUE concerning TRUS appearance after treatment?
a. With an ideal permanent implant, seeds should be distributed evenly throughout the gland with periurethral sparing.
b. TRUS findings are accurate in determining residual cancer following external beam radiation.
c. Androgen ablation will always reduce the size of theprostate by more than 50% regardless of baseline size.
d. With prostate-specific antigen (PSA) recurrence following radical prostatectomy, the anastomosis should be biopsied.
e. Prostate volume decreases by more than 50% at 6 months using agents such as finasteride.
a. With an ideal permanent implant, seeds should be distributed evenly throughout the gland with periurethral sparing.
Which of the following statements about antibiotic prophylaxis for TRUS biopsy is TRUE?
a. It eliminates the risk of any infection.
b. It reduces the risk of febrile urinary tract infection requiring hospitalization but does not prevent them.
c. It is not necessary if the probe is sterilized and an enema is given.
d. Epididymitis is the most common infection after TRUS biopsy even if antibiotics are used.
e. Bacteriuria is the only indication for antibiotics after TRUS prostate biopsy.
b. It reduces the risk of febrile urinary tract infection requiring hospitalization but does not prevent them.
Preferred: Fluoroquinolone
If w valve, IM Ampicilin + Gentamicin
Hematospermia after TRUS biopsy:
a. usually requires hospitalization.
b. is eliminated with the routine use of antibiotics.
c. usually clears immediately after TRUS biopsy.
d. can persist for up to 4 to 6 weeks after TRUS biopsy.
e. is eliminated if the probe is held firmly against the prostate after the needle is passed.
d. can persist for up to 4 to 6 weeks after TRUS biopsy.
Which of the following statements is TRUE in men with a negative prostate biopsy?
a. They can be assured that no cancer is present.
b. They will require repeated biopsy if one of the cores contains seminal vesicle.
c. Transurethral biopsy is the next step after an initial negative biopsy.
d. Additional biopsies demonstrate decreasing yield of detecting cancer, and the cancer tends to be of lower grade and stage.
e. They should undergo transperineal biopsy for all future biopsies because these have been shown to be the most accurate approach in large randomized European trials.
d. Additional biopsies demonstrate decreasing yield of detecting cancer, and the cancer tends to be of lower grade and stage.
Risk factors for prostate biopsy related infection include all of the following EXCEPT:
a. recent antibiotic use.
b. diabetes mellitus.
c. prostate enlargement.
d. foreign travel.
e. White race.
e. White race.
Which of the following statements is TRUE concerning TRUS/magnetic resonance imaging (MRI) fusion biopsy?
a. It must be performed in an “in-bore MRI.”
b. The MRI must be obtained within 24 hours of the prostate biopsy.
c. TRUS/MRI fusion biopsy relies on coregistration of the MRI and TRUS images at the time of biopsy.
d. It relies on a method known as “cognitive fusion.”
e. Any MRI of the prostate can be used for the fusion biopsy.
c. TRUS/MRI fusion biopsy relies on coregistration of the MRI and TRUS images at the time of biopsy.
