Ch. 35 WS

Question 1

Where in the prostate do most cancers occur?

Answer 1

in the peripheral glands

Question 2

Where in the prostate does most benign hyperplasia occur?

Answer 2

central (periurethral) portion

Question 3

List the nodes (in order) in which prostate cancer spreads.

Answer 3

Nodes: Periprostatic, obturator, iliac, hypogastric, common iliac, and periaortic.

Question 4

List the signs and symptoms of prostate cancer (clinical presentation).

Answer 4

Decreased urinary stream, frequency, difficulty in starting urination, dysuria, and infrequently even hematuria.

Question 5

What is a transurethral resection?

Answer 5

A surgical procedure of the prostate performed for lower urinary tract obstructive symptoms

Question 6

What is the standard method used to diagnose prostate cancer?

Answer 6

Physical and rectal examination

Question 7

What is the sensitivity rate for a digital rectal exam?

Answer 7

70%

Question 8

What is the specificity rate for a digital rectal exam?

Answer 8

50%

Question 9

What is the most common histologic type of prostate cancer?

Answer 9

adenocarcinoma

Question 10

What stage disease is prostate cancer that has invaded the seminal vesicles?

Answer 10

T3b

Question 11

What two stages of prostate cancer indicate localized disease limited to the prostate?

Answer 11

T1 and T2

Question 12

What stage disease is prostate cancer that is fixed to the pelvic sidewall or invaded the bladder or rectum?

Answer 12

T4

Question 13

What does M1b mean in the staging of prostate cancer?

Answer 13

Metastasized to bone

Question 14

List the instances in which observation may be a good course of treatment (be sure to read the whole section under the observation heading).

Answer 14

• Patients older than 75 years of age,
• 65-75 year old patients with small, well-differentiated tumors,
• T1-T2 stage tumor,
• Gleason sore of 2-6,
• a PSA less than 10 ng/mL and
• a life expectancy of less than 5 years

Question 15

Which patients are good candidates for a prostatectomy?

Answer 15

Patients with resectable stage T1 or T2 prostate cancer who are in good general medical condition and have a life expectancy of at least 10 years.

Question 16

Which patients are good candidates for external beam radiation and what other treatment is often included with radiation?

Answer 16

Stage T3 along with hormone therapy

Question 17

Which patients are good candidates for radioactive seed implants?

Answer 17

Patients with early stage (T1c, T2a-b), low-grade (Gleason sore ,< or = 6), low PSA(< or =10 ng/mL).

Question 18

What permanent sources are used for implants?

Answer 18

I-125 and palladium-103

Question 19

How does hormone therapy work?

Answer 19

Cuts off the supply of testosterone

Question 20

Which patients are good candidates for chemotherapy?

Answer 20

Patients whose cancer has spread outside of the prostate or whose disease does not respond to hormone therapy.

Question 21

When receiving external beam radiation, what determines if the seminal vesicles are to be included in the treatment field?

Answer 21

When the risk of involvement is at least in the 10% - 15% range (patients with PSA values greater than 10 ng/mL and with tumors with Gleason scores greater than 6.

Question 22

What is the conventional dose and fractionation scheme to treat the prostate?

Answer 22

76Gy (7600cGy) in 38 fractions with 2 Gy(200cGy) per fraction.

Question 23

What is the dose for permanent implants alone?

Answer 23

160Gy

Question 24

If a patient is getting external beam radiation followed by permanent seed implants as a boost, what is the typical dose for the external beam portion?

And how much is given during the boost?

Answer 24

45 Gy

110Gy with Iodine-125(I-125) and 90 Gy with Palladium-103(Pd-103)

Question 25

What is the dose used for HDR and what radioisotope is used?

Answer 25

45.5 Gy using Iridium-192(Ir-192)

Question 26

List three radioactive isotopes used to treat pain due to metastatic prostate cancer to the bone.

Answer 26

Strontium-89, radium-226, Samarium-153

Question 27

List some acute side effects of radiation to the prostate.

Answer 27

Diarrhea, abdominal cramping, rectal discomfort, and occasionally rectal bleeding which may be caused by transient proctitis.

Question 28

What is the clinical presentation for testicular cancer?

Answer 28

Painless swelling or nodular mass in the scrotum

Also sometimes, patients report a dull ache, heaviness, or puling sensation in the scrotum or an aching sensation in the lower abdomen.

Question 29

Why is a biopsy of the testicular mass not recommended?

Answer 29

Because seeding into the scrotum could occur and further the disease

Question 30

What is the recommended procedure to make a diagnosis for testicular cancer?

Answer 30

Radical orchiectomy through an inguinal incision

Question 31

List two critical structures when treating testicular cancer and the maximum dose to be delivered to each of these structures/organs.

Answer 31

Kidney and liver.

If the primary radiation therapy field encompasses most of one kidney, care must be taken to protect at least 2/3 of the kidney from receiving doses higher than 1800 cGy. Limit the dose to a significant volume of the liver to less than 3000 cGy.

Question 32

What is BPH?

Answer 32

Benign Prostatic Hypertrophy-Enlarged prostate.

Common disorder of men over 65 that is hyperplasia of prostatic tissue, with formation of nodules surrounding the urethra. Can lead to compression of urethra and obstruction of urine.

Is not associated with prostate cancer.

Question 33

What is the most common malignancy of males in the U.S.?

Answer 33

Prostate cancer

Question 34

Explain how the Gleason scale works.

Answer 34

Gleason devised a quantitative histologic grading system based on the morphologic tumor characteristics

The primary and secondary tumor grades are labeled from 1-5.

Question 35

Define nadir as it relates to prostate cancer?

Answer 35

The PSA nadir is the lowest level that the PSA reaches following treatment. It’s an indication of how effective the treatment was and how likely cancer is to recur but the nadir needs to be maintained to be a good indication of the effectiveness of treatment; therefore, measurements should be taken over a period of time

Question 36

What is PSA and what is its relationship to prostate cancer?

Answer 36

Prostate Specific antigen. It is a serum marker which can indicate a higher risk for prostate cancer if elevated.

Question 37

Where is the perineum located in males?

Answer 37

Between the scrotum and anus

Question 38

What is cryptorchidism?

And What is its relationship to testicular cancer?

Answer 38

one or both of the testes fails to descend into the proper position in the scrotum which usually happens in the third trimester of pregnancy.

Increases risk of testicular cancer

Question 39

What age group is most susceptible to testicular cancer?

Answer 39

15-35 year old age group

Question 40

How does testicular cancer treatment affect fertility and as a result what might the patient choose to do in order to ensure he can still have children?

Answer 40

Chemotherapy commonly causes infertility during treatment and for an undetermined amount of time afterwards. Radiation therapy is thought to not affect the patient’s fertility, but a small dose does reach the opposite testicle. For these reasons it is often necessary to deposit sperm in a sperm bank before any treatment has started.