Prostate

Question 1

Where does >90% of BPH develop?

Answer 1

Transition zone

Question 2

Where does > 70% of prostate cancer develop[?

Answer 2

Peripheral zone

Question 3

Describe PSA

Answer 3

1. glycoprotein: part of the kallikrein family (also hk3).

2. functions as a serine protease

Question 4

Where is PSA produced and secreted?

Answer 4

1. Produced by epithelial cells in the prostatic acini* and ducts
2. Secreted into the seminal fluid.

Question 5

What are the other forms of PSA?

Answer 5

1. Pre-Pro PSA
2. Pro-PSA
   A. Native form (-7)
   B. Truncated forms (-5, -4, -2)
3. PSA

Question 6

What fluids contain PSA?

Answer 6

1. Semen
2. Amniotic fluid
3. Breast milk
4. Saliva
5. Female urine
6. Female serum

Question 7

How is PSA present in serum?

Answer 7

1. Free, unbound form (~ 70%)
   A. α1-antichymotrypsin (ACT)
   B. α2- macroglobulin (A2M)
   C. α1-protease inhibitor (API)

Question 8

What are the approaches to improve diagnostic performance and reduce the number of biopsies?

Answer 8

PSA densities

PSA velocity

Question 9

Define PSA density

Answer 9

1. an adjustment that divides the PSA measurement by the gland volume
2. fPSA/total PSA or tPSA ratio

Question 10

Define PSA velocity

Answer 10

A. monitors the change in PSA with time.

B. Greater than 0.75 ng/mL per year is suggestive of cancer bc prostate cancer is typically slow growing

Question 11

What are the assays for prostate disease?

Answer 11

1. tPSA: measure free and complex forms, primarily ACT
2. Free PSA
3. Complex PSA

Question 12

What are the low risk parameters for PSA?

Answer 12

<4.0 ng/ml

Question 13

What is the PSA diagnostic grey zone?

Answer 13

4-10 ng/ml

Question 14

What is the PSA high risk for cancer?

Answer 14

> 10 ng/ml

Question 15

What are the risk factors for prostate cancer?

Answer 15

Black race
Family history
High-fat/low-vegetable diet

Question 16

What are the preventative methods for prostate cancer?

Answer 16

Annual PSA and DRE after age 50

Question 17

what is the clinical presentation of prostate cancer?

Answer 17

1. Most common is asymptomatic elevation in PSA
2. DRE findings of asymmetric indurations (hardening) or nodules are suggestive.
3. Less common are obstructive symptoms, new onset ED, hematuria or hematospermia

Question 18

What is %fPSA

Answer 18

% fPSA = (fPSA)/(tPSA) x 100

Question 19

What is the % fPSA of men without prostate cancer?

Answer 19

> 25%

Question 20

What is the fPSA of men with a risk for prostate cancer?

Answer 20

<25%

Question 21

What is the cutoff for %fPSA to detect 90% of cancers?

Answer 21

27 %fPSA

Question 22

What are the ri for PSA based on age?

Answer 22

0-2.5 aged 40-49 years
0-3.5 aged 50-59 years
0-4.5 aged 60-69 years
0-6.5 aged 70-79 years

Question 23

What are the ri for black males for PSA based on age?

Answer 23

0-2 for men aged 40-49 years
0-4 for men aged 50-59 years
0-4.5 for men aged 60-69 years
0-5.5 for men aged 70-79 years

Question 24

How do you treat early prostate cancer?

Answer 24

1. Radical prostatectomy
2. External beam radiation
3. Brachytherapy (use of radioactive implants at the treatment site)

Question 25

How do you treat locally advanced prostate cancer?

Answer 25

treat with a combination of surgical, radiation, and hormonal therapy.

Question 26

How do you treat metastatic prostate disease?

Answer 26

1. Incurable

2. can be managed with hormonal therapy (ADT) for 2-10 years