PROSTATE CANCER

Question 1

Most common non-cutaneous cancer in American men and second leading cause of cancer related death in men **

Answer 1

Prostate Cancer.**

Question 2

Risk factors

Answer 2

(a) African-American race,
(b) Family history of prostatic cancer,
(c) History of high dietary fat intake

Question 3

MOST prostate cancers are detected because of**

Answer 3

elevations in serum PSA (Not DRE)**

Question 4

Most often patient is asymptomatic or symptomatic.

Answer 4

asx

Question 5

Axial skeleton is most common site of metastases

Answer 5

Patient may present with back pain or pathologic fracture

Question 6

Differential Diagnosis

Answer 6

(1) Benign prostate hyperplasia
(2) Prostatitis
(3) Interstitial cystitis

Question 7

Laboratory orders

Answer 7

(1) Prostate specific antigen
(2) Miscellaneous lab
(a) BUN and Creatinine
(b) Alkaline phosphatase and calcium
(c) CBC
(3) Prostate biopsy
(a) Transrectal ultrasound guided biopsy
1) Standard method for detection and confirmation of prostate cancer

Question 8

Laboratory findings/justifications

Answer 8

(1) Prostate specific antigen (PSA) will be elevated (greater than 4.0ng/ml)
(a) 8-30% of men with intermediate degrees of elevation (4.1-10 ng/mL) will be found to have prostate cancer
(b) 50% and 70% of men with elevations greater than 10 ng/mL will be found to have prostate cancer
(2) Miscellaneous labs
(a) BUN and Creatinine
1) Assessing for renal impairment with urinary retention
(b) Alkaline phosphatase and calcium
1) Assessing for bony metastases
(c) CBC
1) Assessing for anemia
(3) Prostate biopsy
(a) Transrectal ultrasound guided biopsy
1) Standard method for detection and confirmation of prostate cancer

Question 9

Imaging

Answer 9

(1) Transrectal ultrasonography
(2) MRI
(a) Evaluating the prostate and regional lymph nodes
(3) Bone scan
(a) Evaluating for bony metastases

Question 10

Screening for prostate cancer

Answer 10

(1) Digital rectal exam
(a) Assessing for focal nodules or areas of induration
(2) Prostate specific antigen testing
(a) Baseline test offered at 50 unless there are risk factors
(b) Age 40 to 45 with risk factors including
1) African American men
2) Family history of prostate cancer
3) Known or likely to have BRCA1 or BRCA2 mutations
(3) Transrectal ultrasound
(a) Not considered a first line screening tool

Question 11

Treatment

Answer 11

(1) As dictated by urology and oncology
(2) Possible therapies include
(a) Active surveillance
(b) Radical prostatectomy
(c) Radiation therapy
(d) Cryosurgery
(e) Androgen deprivation therapy for advanced disease

Question 12

Complications

Answer 12

(1) Likelihood of success of active surveillance or treatment can be predicted using risk assessment tools that usually combine stage, grade, PSA level, and number and extent of positive prostate biopsies.
(2) Complications are related to tumor burden and metastases and include
(a) Urinary retention
(b) Renal failure
(c) Metastatic bone pain
(d) Thromboembolic events
(e) Neurologic symptoms
(f) Pathologic fractures

Question 13

Follow up

Answer 13

All patients with a focal nodule, or induration on DRE or elevated PSA MUST be referred to urology