Focal Therapy for Prostate Cancer + RALP + Bx

Question 1

Clinical Vignette: A 65-year-old male undergoes radical prostatectomy. The pathology report reveals the presence of multiple lesions, including one that is significantly larger and of a higher grade compared to others.

Question: Which lesion is most likely to determine the grade and stage of this patient’s prostate cancer?

A. The smallest lesion
B. The index lesion
C. A nonindex lesion
D. All lesions equally contribute

Answer 1

Correct Answer: B. The index lesion

Explanation:

A: Incorrect. The smallest lesion is unlikely to determine the grade and stage.
B: Correct. Most of the time, the grade/stage is determined by the index lesion.
C: Incorrect. Only 16% of extracapsular extensions were from nonindex lesions.
D: Incorrect. Most of the tumor volume and grade/stage are contributed by the index lesion.
Memory Tool: Think of the index lesion as the “main character” in the story of prostate cancer.

Reference: Ohori et al. (2006)

Rationale: Understanding the role of the index lesion in prostate cancer helps in better diagnosis and treatment planning.

Question 2

Clinical Vignette: A 70-year-old man with suspected prostate cancer undergoes multiparametric MRI (mpMRI) with gadolinium-based contrast.

Question: What is the primary benefit of using dynamic contrast-enhanced (DCE) imaging in this scenario?

A. Improve the detection of EPE
B. Preferentially detect high-grade lesions
C. Detect lesions in the anterior zone
D. Accurately identify the index lesion

Answer 2

Correct Answer: B. Preferentially detect high-grade lesions

Explanation:

A: Incorrect. Although mpMRI can detect EPE, it’s not the primary benefit of DCE imaging.
B: Correct. DCE imaging preferentially detects larger and higher-grade cancer foci.
C: Incorrect. Anterior zone detection is a benefit but not the primary one for DCE.
D: Incorrect. While mpMRI can identify the index lesion, DCE primarily detects high-grade lesions.
Memory Tool: DCE = “D”etects “C”ritical (high-grade) “E”lements.

Reference: Arumainayagam et al. (2013); Rosenkrantz et al. (2012)

Rationale: Knowing the capabilities of imaging techniques assists in choosing the most appropriate diagnostic method.

Question 3

Clinical Vignette: A 62-year-old man diagnosed with prostate cancer is being considered for focal therapy. Several small, low-grade tumors have been identified in addition to one main lesion.

Question: What volume cutoff is often used to define an insignificant prostate cancer?

A. 1 mL
B. 0.5 mL
C. 2 mL
D. 0.2 mL

Answer 3

Correct Answer: B. 0.5 mL

Explanation:

A, C, D: Incorrect. These are not the established cutoffs for defining insignificant prostate cancer.
B: Correct. An insignificant cancer is often defined using <0.5 mL as a cutoff.
Memory Tool: Think of 0.5 mL as the “Halfway Point to Insignificance.”

Reference: Stamey et al. (1993)

Rationale: Knowing the volume cutoff for insignificant cancer aids in treatment planning and patient counseling.

Question 4

Clinical Vignette: A 58-year-old man undergoes mpMRI to evaluate a suspected prostate malignancy. The radiologist reports that the images have high specificity.

Question: What is the reported range of specificity for mpMRI in the detection of extraprostatic extension (EPE)?

A. 40% to 60%
B. 73% to 91%
C. 20% to 40%
D. 60% to 70%

Answer 4

Correct Answer: B. 73% to 91%

Explanation:

A, C, D: Incorrect. These are not the reported ranges for mpMRI specificity in EPE detection.
B: Correct. The specificity for mpMRI in detecting EPE is between 73% and 91%.
Memory Tool: Think of “Specificity” as a “Specific Range of 73-91.”

Reference: Cerantola et al. (2013); Feng et al. (2015); Kayat Bittencourt et al. (2015); Raskolnikov et al. (2015); Somford et al. (2013)

Rationale: Accurate understanding of imaging specificity is crucial for interpreting diagnostic results.

Question 5

Correct Answer: B. 73% to 91%

Explanation:

A, C, D: Incorrect. These are not the reported ranges for mpMRI specificity in EPE detection.
B: Correct. The specificity for mpMRI in detecting EPE is between 73% and 91%.
Memory Tool: Think of “Specificity” as a “Specific Range of 73-91.”

Reference: Cerantola et al. (2013); Feng et al. (2015); Kayat Bittencourt et al. (2015); Raskolnikov et al. (2015); Somford et al. (2013)

Rationale: Accurate understanding of imaging specificity is crucial for interpreting diagnostic results.

Answer 5

Correct Answer: C. Monitoring PSA levels post-treatment

Explanation:

A, B, D: Correct. These are key components of a successful focal therapy strategy.
C: Incorrect. After focal therapy, PSA is less relevant as its levels are affected by the amount of residual prostate epithelium.
Memory Tool: Post-Focal Therapy, PSA is “Post-Scripted Away.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the limitations of PSA post-focal therapy helps in choosing more accurate monitoring tools.

Question 6

Question 6: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 68-year-old man has been diagnosed with multifocal prostate cancer. Genetic studies are being considered.

Question: What is suggested about the origin of metastatic or lethal prostate cancer based on genetic studies?

A. Polyclonal origin
B. Biclonal origin
C. Monoclonal origin
D. Multiclonal origin

Answer 6

Correct Answer: C. Monoclonal origin

Explanation:

A, B, D: Incorrect. Genetic studies suggest a monoclonal origin of metastatic or lethal prostate cancer.
C: Correct. Most, if not all, metastatic prostate cancers have a monoclonal origin.
Memory Tool: Metastatic or lethal = “Mono” makes it critical.

Reference: Liu et al. (2009)

Rationale: Understanding the clonal origin can guide targeted therapies and prognostic assessments.

Question 7

Question 7: Topic - Advanced Imaging Techniques in Prostate Cancer
Clinical Vignette: A 60-year-old man with suspected prostate cancer undergoes mpMRI. The radiologist suggests additional imaging for the anterior zone of the prostate.

Question: Why is additional imaging for the anterior zone often recommended?

A. It is highly vascularized
B. It is inaccessible to TRUS biopsy
C. It is prone to calcifications
D. It is usually more malignant

Answer 7

Correct Answer: B. It is inaccessible to TRUS biopsy

Explanation:

A, C, D: Incorrect. These are not the primary reasons for additional imaging of the anterior zone.
B: Correct. Anterior-zone cancers are generally diagnosed late because the location is relatively inaccessible to TRUS biopsy.
Memory Tool: Anterior = “A”ccess “N”ot “T”ypically “E”asy for “R”egular “I”maging or “O”btaining “R”esults.

Reference: Nevoux et al. (2012); Al-Ahmadie et al. (2008); Bott et al. (2002)

Rationale: Being aware of the limitations of TRUS biopsy in the anterior zone can guide better diagnostic planning.

Question 8

Question 8: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 50-year-old man is discussing treatment options for his recently diagnosed prostate cancer. Focal therapy is being considered.

Question: What is the biological basis for considering focal therapy in this patient?

A. All prostate cancers are low-grade
B. The index lesion drives cancer progression
C. Focal therapy treats all lesions equally
D. Secondary cancers are usually high-grade

Answer 8

Correct Answer: B. The index lesion drives cancer progression

Explanation:

A, C, D: Incorrect. These statements are not the basis for considering focal therapy.
B: Correct. The index lesion is the dominant tumor focus that drives cancer progression and metastasis.
Memory Tool: Focal Therapy = Focus on the “Index” for the “Outcome.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the biological basis for focal therapy helps in choosing the most appropriate treatment modality.

Question 9

Question 9: Topic - Advanced Imaging Techniques in Prostate Cancer
Clinical Vignette: A 72-year-old man is undergoing preprostatectomy mpMRI. The goal is to accurately identify the index lesion.

Question: What is the reported sensitivity of mpMRI for detecting index lesions?

A. 47%
B. 72%
C. 80%
D. 35%

Answer 9

Correct Answer: C. 80%

Explanation:

A, B, D: Incorrect. These are not the reported sensitivities for detecting index lesions.
C: Correct. The sensitivity of mpMRI for detecting index lesions is reported to be 80%.
Memory Tool: “Index” = “80,” both end with the letter “x.”

Reference: Le et al. (2015)

Rationale: Knowing the sensitivity of mpMRI for index lesions assists in its utility for pre-surgical planning.

Question 10

Question 10: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 64-year-old man has successfully undergone prostate focal therapy. Follow-up evaluations are being planned.

Question: Which of the following is NOT recommended for assessing the treated area post-focal therapy?

A. MRI
B. Prostate biopsies
C. PSA levels
D. Clinical examination

Answer 10

Correct Answer: C. PSA levels

Explanation:

A, B, D: Correct. These are recommended for assessing the treated area post-focal therapy.
C: Incorrect. PSA is less relevant for post-focal therapy evaluation as it is affected by the amount of residual prostate epithelium.
Memory Tool: Post-Focal = “PSA Postponed.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing what is not recommended for follow-up assessments post-focal therapy helps in better patient management.

Question 11

Question 11: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 59-year-old man is diagnosed with prostate cancer and is considering focal therapy. His medical team is discussing the strategy for treatment.

Question: What is essential for a successful focal therapy strategy?

A. Only complete ablation of the index lesion
B. A multidisciplinary team and patient compliance
C. Sole reliance on advanced imaging
D. Ignoring secondary cancers

Answer 11

Correct Answer: B. A multidisciplinary team and patient compliance

Explanation:

A, C, D: Incorrect. These are not sufficient alone for a successful focal therapy strategy.
B: Correct. A multidisciplinary team and patient compliance are key components for a successful focal therapy strategy.
Memory Tool: “Multi-Team, Multi-Compliance” for Multi-faceted Success.

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the key components of a successful focal therapy strategy aids in optimal treatment planning.

Question 12

Question 12: Topic - Advanced Imaging Techniques in Prostate Cancer
Clinical Vignette: A 66-year-old man undergoes mpMRI for evaluation of prostate cancer. The findings suggest the possibility of extraprostatic extension (EPE).

Question: What is the reported positive predictive value (PPV) range for mpMRI in the detection of EPE?

A. 10% to 25%
B. 36% to 85%
C. 50% to 60%
D. 90% to 100%

Answer 12

Correct Answer: B. 36% to 85%

Explanation:

A, C, D: Incorrect. These are not the reported PPV ranges for mpMRI in EPE detection.
B: Correct. The PPV for mpMRI in detecting EPE is between 36% and 85%.
Memory Tool: “PPV for EPE” rhymes with “36 to 85.”

Reference: Cerantola et al. (2013); Feng et al. (2015); Kayat Bittencourt et al. (2015); Raskolnikov et al. (2015); Somford et al. (2013)

Rationale: Understanding the PPV can guide the interpretation and the need for confirmatory tests for EPE.

Question 13

Question 13: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 47-year-old man with localized prostate cancer is exploring focal therapy options. Various ablation technologies are being considered.

Question: Which of the following is NOT an ablation pattern used in focal therapy for prostate cancer?

A. Hemiablation
B. Quadrant ablation
C. Lesion ablation
D. Whole-gland ablation

Answer 13

Correct Answer: D. Whole-gland ablation

Explanation:

A, B, C: Correct. These are patterns of ablation used in focal therapy.
D: Incorrect. Whole-gland ablation is not a focal therapy pattern; it targets the entire gland.
Memory Tool: “Focal is Local; Whole-gland is Grand.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the various ablation patterns helps in selecting the most appropriate focal therapy method.

Question 14

Question 14: Topic - Advanced Imaging Techniques in Prostate Cancer
Clinical Vignette: A 73-year-old man with suspected prostate cancer is being evaluated. His medical team is considering other imaging modalities besides mpMRI.

Question: What is the miss rate associated with mpMRI for evaluating the prostate gland before focal therapy?

A. 5% to 10%
B. 10% to 15%
C. 20% to 25%
D. 30% to 40%

Answer 14

Correct Answer: B. 10% to 15%

Explanation:

A, C, D: Incorrect. These are not the reported miss rates for mpMRI in evaluating the prostate gland before focal therapy.
B: Correct. The miss rate with mpMRI is 10% to 15%.
Memory Tool: “Miss and mpMRI both start with ‘m’; the rate is 10 to 15.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Awareness of the limitations of mpMRI aids in the need for complementary diagnostic methods.

Question 15

Question 15: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 52-year-old man has recently undergone focal therapy for prostate cancer. His healthcare team is planning future research endeavors.

Question: What should future research in focal therapy for prostate cancer focus on?

A. Completely replacing whole-gland treatment
B. Ignoring the role of imaging
C. Better patient selection and cost-effectiveness studies
D. Limiting the use of ablation technologies

Answer 15

Correct Answer: C. Better patient selection and cost-effectiveness studies

Explanation:

A, B, D: Incorrect. These are not the recommended focuses for future research in focal therapy.
C: Correct. Future research should focus on better patient selection using clinical, imaging, and/or genetic biomarkers, and cost-effectiveness studies.
Memory Tool: “Future is Focused on the Finest and Most Feasible.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the direction of future research can help in anticipating advancements in focal therapy.

Question 16

Question 16: Topic - Advanced Imaging Techniques in Prostate Cancer
Clinical Vignette: A 67-year-old man with suspected prostate cancer undergoes mpMRI. The radiologist also considers using multiparametric ultrasonography or PSMA-PET CT/MRI for further evaluation.

Question: Which of the following statements is true regarding the role of mpMRI in prostate focal therapy?

A. mpMRI has fully replaced systematic biopsy
B. mpMRI has a key role but systematic biopsy remains necessary
C. mpMRI is not recommended for focal therapy
D. mpMRI has no miss rate

Answer 16

Correct Answer: B. mpMRI has a key role but systematic biopsy remains necessary

Explanation:

A, C, D: Incorrect. These statements are not true regarding the role of mpMRI in focal therapy.
B: Correct. mpMRI has become a key enabler for prostate focal therapy, but a 10% to 15% miss rate means systematic biopsy remains necessary.
Memory Tool: mpMRI is “Major but Misses a Minor.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the limitations of mpMRI can guide better diagnostic and therapeutic decision-making.

Question 17

Clinical Vignette: A 63-year-old man who has undergone focal therapy for prostate cancer is due for a follow-up. His healthcare team discusses the monitoring strategy.

Question: What is less relevant in evaluating therapeutic success after focal therapy?

A. MRI
B. Prostate biopsies
C. PSA levels
D. Clinical examination

Answer 17

Correct Answer: C. PSA levels

Explanation:

A, B, D: Correct. These are recommended for evaluating therapeutic success after focal therapy.
C: Incorrect. PSA levels are less relevant because they are affected by the amount of residual prostate epithelium.
Memory Tool: “Post-Focal, Put PSA Aside.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the limitations of PSA in the post-focal therapy setting aids in better patient management.

Question 18

Clinical Vignette: A 55-year-old man is considering focal therapy for prostate cancer. The healthcare team discusses the choice of ablative technology.

Question: Which of the following is NOT a consideration in choosing the ablative technology for focal therapy?

A. Location of the tumor
B. Desired ablative technology
C. Patient’s age
D. Anatomic considerations

Answer 18

Correct Answer: C. Patient’s age

Explanation:

A, B, D: Correct. These are considerations in choosing the ablative technology.
C: Incorrect. Patient’s age is not specifically mentioned as a consideration for choosing ablative technology in focal therapy.
Memory Tool: “Ablation without Age-ation.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the considerations for choosing ablative technology ensures optimal treatment planning.

Question 19

Question 19: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 61-year-old man with prostate cancer undergoes focal therapy. The medical team is considering future targeted treatment options.

Question: What is the post-treatment strategy after focal therapy?

A. Ignoring persistent or de novo disease
B. Converting to whole-gland treatment as necessary
C. No further monitoring is required
D. Focusing only on PSA levels

Answer 19

orrect Answer: B. Converting to whole-gland treatment as necessary

Explanation:

A, C, D: Incorrect. These are not the recommended post-treatment strategies after focal therapy.
B: Correct. The post-treatment strategy includes future targeted treatment of either persistent or de novo disease, or conversion to whole-gland treatment as necessary.
Memory Tool: “Focal to Whole, if the Situation Unfolds.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the post-treatment strategy is crucial for long-term patient management.

Question 20

Question 20: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A research team is planning a study on the efficacy of focal therapy in prostate cancer. They aim to improve patient selection.

Question: What should be the focus of future research endeavors in focal therapy?

A. Replacing other treatment modalities
B. Ignoring the role of imaging
C. Better patient selection and cost-effectiveness
D. Limiting the use of advanced imaging

Answer 20

Question 20: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A research team is planning a study on the efficacy of focal therapy in prostate cancer. They aim to improve patient selection.

Question: What should be the focus of future research endeavors in focal therapy?

A. Replacing other treatment modalities
B. Ignoring the role of imaging
C. Better patient selection and cost-effectiveness
D. Limiting the use of advanced imaging

Question 21

Question 21: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 58-year-old man with prostate cancer is being counseled about treatment options. The possibility of focal therapy is discussed.

Question: What is the biologic basis of focal therapy in prostate cancer?

A. The index lesion is usually low-grade
B. All prostate cancers are multifocal
C. The index lesion drives cancer progression and metastasis
D. Secondary cancers are usually more aggressive

Answer 21

Correct Answer: C. The index lesion drives cancer progression and metastasis

Explanation:

A, B, D: Incorrect. These statements do not represent the biologic basis for focal therapy.
C: Correct. The index lesion is the dominant tumor focus that drives cancer progression and metastasis.
Memory Tool: “Index is the Instigator.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the biologic basis helps in selecting appropriate treatment modalities for prostate cancer.

Question 22

Question 24: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 64-year-old man has undergone focal therapy for prostate cancer. The medical team is planning post-treatment monitoring.

Question: Which of the following is recommended to assess the untreated (outfield) area after focal therapy?

A. Only PSA levels
B. MRI and prostate biopsies
C. Clinical examination alone
D. No further assessment is needed

Answer 22

orrect Answer: B. MRI and prostate biopsies

Explanation:

A, C, D: Incorrect. These are not the recommended methods for assessing the untreated area post-focal therapy.
B: Correct. MRI and prostate biopsies are recommended to assess both the treated (infield) and untreated (outfield) areas.
Memory Tool: “For Outfield Assessment, Bring in Both MRI and Biopsies.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the recommended post-treatment assessments can guide long-term patient management.

Question 23

Question 25: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 49-year-old man with prostate cancer is considering focal therapy. He inquires about the patterns in which focal therapy can be applied.

Question: Which of the following is a pattern of focal therapy?

A. Whole-gland ablation
B. Quadrant ablation
C. Global ablation
D. Peripheral ablation

Answer 23

Correct Answer: B. Quadrant ablation

Explanation:

A, C, D: Incorrect. These are not patterns of focal therapy.
B: Correct. Focal therapy can be applied in various patterns including quadrant ablation.
Memory Tool: “Quadrant for Quality Control in Focal Therapy.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the patterns of focal therapy helps in discussing treatment options with patients.

Question 24

Question 26: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 57-year-old man with prostate cancer is exploring treatment options. Focal therapy is discussed, and the team considers the patient’s compliance for follow-up.

Question: What is crucial for the success of a focal therapy strategy?

A. Patient’s age
B. Complete reliance on imaging
C. Patient compliance to follow-up
D. Immediate conversion to whole-gland treatment

Answer 24

Correct Answer: C. Patient compliance to follow-up

Explanation:

A, B, D: Incorrect. These factors are not crucial for the success of a focal therapy strategy.
C: Correct. A successful focal therapy strategy depends on patient compliance to follow-up.
Memory Tool: “Compliance Completes the Focal Circle.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the importance of patient compliance helps in patient selection for focal therapy.

Question 25

Question 27: Topic - Advanced Imaging Techniques in Prostate Cancer
Clinical Vignette: A 65-year-old man is suspected of having anterior zone prostate cancers. His medical team is discussing diagnostic strategies.

Question: What advantage does mpMRI offer in diagnosing anterior zone prostate cancers?

A. It is less sensitive in the anterior zone
B. It improves the detection of anterior zone prostate cancers
C. It cannot detect cancers in the anterior zone
D. It has no advantages in the anterior zone

Answer 25

Correct Answer: B. It improves the detection of anterior zone prostate cancers

Explanation:

A, C, D: Incorrect. These statements are not true regarding mpMRI in diagnosing anterior zone prostate cancers.
B: Correct. mpMRI improves the detection of anterior zone prostate cancers.
Memory Tool: “Anterior Attention Amplified by mpMRI.”

Reference: Nevoux et al. (2012); Al-Ahmadie et al. (2008); Bott et al. (2002)

Rationale: Knowing the advantages of mpMRI in the anterior zone aids in diagnostic planning.

Question 26

Question 28: Topic - Focal Therapy for Prostate Cancer
Clinical Vignette: A 60-year-old man who has undergone focal therapy for prostate cancer is due for a follow-up. His PSA levels are found to be elevated.

Question: What is the relevance of elevated PSA levels after focal therapy?

A. Highly relevant, indicative of therapeutic failure
B. Not relevant due to residual prostate epithelium
C. Only relevant if accompanied by symptoms
D. Always indicates a need for immediate whole-gland treatment

Answer 26

Correct Answer: B. Not relevant due to residual prostate epithelium

Explanation:

A, C, D: Incorrect. Elevated PSA levels are not necessarily indicative of therapeutic failure or a need for whole-gland treatment after focal therapy.
B: Correct. Elevated PSA levels are less relevant after focal therapy as they are affected by the amount of residual prostate epithelium.
Memory Tool: “Post-Focal PSA? Partially Pointless.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the limitations of PSA post-focal therapy helps in better patient management.

Question 27

Correct Answer: B. Not relevant due to residual prostate epithelium

Explanation:

A, C, D: Incorrect. Elevated PSA levels are not necessarily indicative of therapeutic failure or a need for whole-gland treatment after focal therapy.
B: Correct. Elevated PSA levels are less relevant after focal therapy as they are affected by the amount of residual prostate epithelium.
Memory Tool: “Post-Focal PSA? Partially Pointless.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Understanding the limitations of PSA post-focal therapy helps in better patient management.

Answer 27

Correct Answer: A. Laser

Explanation:

B, C, D: Incorrect. These are not commonly used as ablative technologies in focal therapy.
A: Correct. Laser is one of the ablative technologies used in focal therapy.
Memory Tool: “Laser Lights the Way in Focal Therapy.”

Reference: Campbell’s Urology textbook 12th edition

Rationale: Knowing the types of ablative technologies can guide discussions on treatment options.

Question 29

Topic: Indications and Contraindications for Laparoscopic and Robotic-Assisted Laparoscopic Radical Prostatectomy (LRP and RALRP)

Clinical Vignette: A 55-year-old male presents with elevated PSA levels and is diagnosed with stage T2 prostate cancer. You are considering different surgical options for the patient.

Question: Which of the following is true regarding the indications for LRP and RALRP?

Choices:

A) Indicated only for stage T1 prostate cancer
B) Not recommended for patients with a Gleason score of 8 or greater
C) Indications are different than those for open surgery
D) Indications are identical to those for open surgery

Answer 29

Correct Answer: D) Indications are identical to those for open surgery

Explanation:

A) LRP and RALRP are indicated for stage T1 or T2, as well as some T3 cancers.
B) Radiographic staging is recommended for patients with a Gleason score of 8 or greater, but they are not automatically disqualified.
C) The indications for LRP and RALRP are identical to those for open surgery.
D) Correct. The indications for LRP and RALRP are identical to those for open surgery.
Memory Tool: Think “LRP and RALRP are not LOCO”; they have the same LOCalized cancer indications as open surgery.

Citation: Campbell’s Urology 12th edition, Laparoscopic and Robotic-Assisted Laparoscopic Radical Prostatectomy section.

Importance: Understanding the indications and contraindications for different surgical approaches is crucial for patient selection and surgical planning.

Question 30

Topic: Use of Preoperative Multiparametric Magnetic Resonance Imaging (mpMRI)

Clinical Vignette: A 60-year-old man with localized prostate cancer is scheduled for surgical intervention. You are discussing the preoperative evaluation with your team.

Question: What is the role of multiparametric MRI (mpMRI) in preoperative planning?

Choices:

A) Not useful for predicting extracapsular extension
B) Primarily used for detecting bone metastases
C) Enhances the ability to predict extracapsular extension
D) Replaces the need for CT and bone scan

Answer 30

Correct Answer: C) Enhances the ability to predict extracapsular extension

Explanation:

A) Incorrect, mpMRI improves the prediction of extracapsular extension.
B) Bone metastases are typically evaluated using a bone scan, not mpMRI.
C) Correct, mpMRI can help predict extracapsular extension, which is useful for surgical planning.
D) CT and bone scan are still recommended for certain high-risk features, and mpMRI does not replace them.
Memory Tool: Think “mpMRI: More Predictive for capsular Reach.”

Citation: Campbell’s Urology 12th edition, Use of Preoperative Multiparametric Magnetic Resonance Imaging section.

Importance: Knowing the role of mpMRI can aid in preoperative planning and patient counseling.

Question 31

Topic: Operating Room Personnel for LRP and RALRP

Clinical Vignette: You are the attending urologist preparing for an RALRP. Your OR team is assembled, and you are reviewing team qualifications.

Question: What is essential regarding the qualifications of the operating room personnel for RALRP?

Choices:

A) Only a skilled scrub technician is necessary
B) Two skilled assistants are always required
C) Only one skilled assistant is generally required
D) No specialized training is needed for the OR team

Answer 31

Correct Answer: C) Only one skilled assistant is generally required

Explanation:

A) While a skilled scrub technician is necessary, it’s not the only requirement.
B) Two skilled assistants may be used but are not always required.
C) Correct, generally only one skilled assistant is required for RALRP.
D) Specialized training is absolutely necessary for all members of the OR team.
Memory Tool: Think “One skilled assistant, One Robotic System.”

Citation: Campbell’s Urology 12th edition, Operating Room Personnel section.

Importance: Proper team training is crucial for the successful execution of these technically demanding procedures.

Question 32

Topic: Anesthesia Considerations for LRP and RALRP

Clinical Vignette: A patient is undergoing RALRP. During the surgery, the anesthesiologist notices rising end-tidal CO2 levels.

Question: What immediate action is most appropriate for the anesthesiologist to consider?

Choices:

A) Stop the surgery immediately
B) Adjust minute and tidal volumes promptly
C) Administer additional anesthesia medication
D) Ignore it, as it is usually not significant

Answer 32

Correct Answer: B) Adjust minute and tidal volumes promptly

Explanation:

A) Stopping the surgery immediately may not be warranted if the issue can be managed.
B) Correct. Prompt adjustment in minute and tidal volumes may be required to manage rising end-tidal CO2 levels.
C) Additional anesthesia medication would not address the issue of rising end-tidal CO2.
D) Rising end-tidal CO2 levels could lead to systemic acidosis if left uncorrected, so it should not be ignored.
Memory Tool: “CO2 high, adjust the sky (volumes).”

Citation: Campbell’s Urology 12th edition, Anesthesia Considerations section.

Importance: Anesthesiologists need to be aware of the potential issues that can arise during LRP and RALRP to react promptly.

Question 33

Topic: Vesicourethral Anastomosis in LRP and RALRP

Clinical Vignette: You are nearing the end of a successful RALRP. You are preparing for the vesicourethral anastomosis.

Question: What is an important consideration regarding vesicourethral anastomosis in RALRP?

Choices:

A) Requires dedicated mucosal eversion sutures at the bladder neck
B) Generally necessitates discontinuous suturing for anastomosis
C) Running continuous suture is generally sufficient
D) Should always be performed using non-absorbable sutures

Answer 33

Correct Answer: C) Running continuous suture is generally sufficient

Explanation:

A) These sutures are commonly used during RRP but are unnecessary in LRP and RALRP.
B) A running continuous suture is usually sufficient for the anastomosis.
C) Correct. A running continuous suture is generally sufficient for the vesicourethral anastomosis in LRP and RALRP.
D) The type of suture is not specified, but a running continuous suture is generally used.
Memory Tool: “Running continuous, no extra fuss.”

Citation: Campbell’s Urology 12th edition, Vesicourethral Anastomosis section.

Importance: Knowing the proper technique for vesicourethral anastomosis helps ensure a successful surgical outcome.

Hope you find this review helpful, Doctor. If you need more details or have specific questions, feel free to ask. 😊

Question 34

Topic: Postoperative Complications Following LRP and RALRP

Clinical Vignette: A 58-year-old male undergoes LRP for localized prostate cancer. Two days postoperatively, he develops fever and chills.

Question: What is the most likely cause of postoperative fever in this patient?

Choices:

A) Urinary tract infection (UTI)
B) Anastomotic leak
C) Pulmonary embolism
D) Surgical site infection

Answer 34

Correct Answer: A) Urinary tract infection (UTI)

Explanation:

A) Correct, UTIs are a common postoperative complication after LRP.
B) Anastomotic leaks generally present with localized pain rather than fever and chills.
C) Pulmonary embolism usually presents with respiratory symptoms.
D) Surgical site infections are less common and typically manifest later.
Memory Tool: “Post-LRP fever? UTI’s the achiever!”

Citation: Campbell’s Urology 12th edition, Postoperative Complications section.

Importance: Recognizing common postoperative complications allows for prompt diagnosis and treatment.

Question 35

Topic: Nerve-Sparing Technique in LRP and RALRP

Clinical Vignette: A 50-year-old man with localized prostate cancer wishes to preserve sexual function. You are considering nerve-sparing techniques.

Question: What is a key factor in the success of nerve-sparing LRP and RALRP?

Choices:

A) Surgeon’s experience
B) Tumor proximity to the neurovascular bundle
C) Patient’s age
D) All of the above

Answer 35

Correct Answer: D) All of the above

Explanation:

A) Surgeon’s experience is crucial for the success of nerve-sparing techniques.
B) Tumor proximity to the neurovascular bundle can limit the feasibility of nerve-sparing.
C) Older age may reduce the success of nerve-sparing due to baseline erectile function.
D) Correct, all these factors are key in the success of nerve-sparing LRP and RALRP.
Memory Tool: “Nerve-Sparing? Look at Experience, Proximity, and Age!”

Citation: Campbell’s Urology 12th edition, Nerve-Sparing Techniques section.

Importance: A comprehensive approach considering multiple factors is necessary for successful nerve-sparing.

Question 36

Topic: Intraoperative Blood Loss in LRP and RALRP

Clinical Vignette: You are operating on a 65-year-old man undergoing RALRP. You want to minimize blood loss.

Question: What is a factor that generally reduces intraoperative blood loss in RALRP compared to open surgery?

Choices:

A) Use of bipolar electrocautery
B) Reduced tissue manipulation
C) Lower intra-abdominal pressure
D) All of the above

Answer 36

Correct Answer: B) Reduced tissue manipulation

Explanation:

A) While bipolar electrocautery can be effective, it is not specific to RALRP.
B) Correct, reduced tissue manipulation generally results in less blood loss in RALRP.
C) In fact, higher intra-abdominal pressure is often used in RALRP, which can increase blood loss.
D) Only reduced tissue manipulation is generally specific to RALRP for reducing blood loss.
Memory Tool: “Less touching, less bleeding.”

Citation: Campbell’s Urology 12th edition, Intraoperative Blood Loss section.

Importance: Knowing the factors that can reduce intraoperative blood loss helps ensure a smoother surgical procedure.

Question 37

The mature prostate is between __ g and remains relatively constant until approximately 50 years of
age, when the gland enlarges in many men; the average prostate volume in a 60- to 70-year-old individual is approximately __ g

Answer 37

20-25

48

Question 38

Prostate gland volume can be used to calculate derivatives
such as the PSA density___

value more suggestive of ca?

Answer 38

PSAD = PSA/ Gland Volume

higher density values (>0.15 ng/mL/cc) are more suggestive of prostate cancer; lower values suggest BPH.

Question 39

Congenital prostatic cystic lesions may arise from either Müllerian (__) or Wolffian (__) structures

Answer 39

Müllerian duct cysts and prostatic utricles

ejaculatory duct and SV cysts

Question 40

Men at elevated risk for having prostate cancer are those older than __ years of age; those who have a __history of prostate cancer and are older than 45 years of age or __; or those with a PSA level greater than 1 ng/ mL at __ years of age and greater than 2 ng/mL at__ years of age

Answer 40

50 years

family

African-American

40

60

Question 41

INITIAL PROSTATE BIOPSY •

Initial diagnosis of prostate cancer based on informed decision making in an asymptomatic patient (4)

Answer 41

Summary: DRE, symptoms,suggestive of mets,detected after TURP

Suspicious digital rectal examination findings/prostate nodule (5%–30% cancer risk)
• To diagnose prostate cancer with symptoms suggestive of prostate cancer
• To diagnose prostate cancer with findings suggestive of metastatic disease (bone lesions and/or adenopathy)
• In the setting of prostate cancer detected on routine transurethral resection of the prostate performed for presumed benign disease