Prostate cancer

Question 1

What is the incidence of prostate cancer?

1 - 17 cases per 100,000
2 - 170 cases per 100,000
3 - 1700 cases per 100,000
4 - 17,000 cases per 100,000

Answer 1

2 - 170 cases per 100,000

Question 2

At what age does the incidence of prostate cancer peak at?

1 - >30
2 - >50
3 - >60
4 - >70

Answer 2

4 - >70

Question 3

Which of the following is NOT a common risk factor for prostate cancer?

1 - Age
2 - Race/ethnicity (highest in Black African ethnicity)
3 - Family history and genetics
4 - Alcohol
5 - Hormonal factors
6 - Environmental factors (exposure to certain chemicals, diet, and lifestyle)

Answer 3

4 - Alcohol

Question 4

Family history and genetics has a role to play as a risk factor in the development of prostate cancer. Which of the following genes, has NOT been associated with prostate cancer?

1 - BRCA1
2 - APC
3 - BRCA2
4 - HOXB13

Answer 4

2 - APC

Common in colon cancer

Question 5

Prostate cancer is the 2nd most common cancer in men and typically affects Afro-Caribbean men more frequently. This can often be asymptomatic early on and only present on a routine check of the prostate. Which of the following is NOT a common symptom associated with prostate cancer?

1 - haematuria
2 - lower urinary tract symptoms (obstruction, hesitancy, retention)
3 - haematospermia (blood in semen)
4 - bone pain with metastasis
5 - flank, groin and back pain
6 - bladder outflow obstruction with AKI
7 - penile discharge

Answer 5

7 - penile discharge

• 5 year survival is 98%

Question 6

Which part of the prostate is predominately affected?

1 - central zone
2 - peripheral zone
3 - transitional zone
4 - urethral zone

Answer 6

2 - peripheral zone

The transitional zone is commonly affected by BPH, which can also cause lower urinary tract symptoms

Question 7

Which of the following patients would be referred on a 2-week pathway due to the risk of prostate cancer?

1 - 40 y/o with PSA >age related range
2 - 65 y/o elevated PSA, urinary tract symptoms and erectile dysfunction
3 - 50 y/o with abnormal DRE with urinary retention and visible haematuria
4 - 30 y/o with elevated PSA, abnormal DRE and visible haematuria
5 - all patients referred

Answer 7

5 - all patients referred

Full NICE referral below:

Consider a prostate‑specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:
any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
erectile dysfunction or
visible haematuria.

Question 8

Which of the following is typically not part of the diagnosis of prostate cancer?

1 - Elevated serum Prostate Specific Antigen (PSA)
2 - Digital rectal examination: induration, asymmetry, nodule
3 - Prostate biopsy
4 - Cystoscopy

Answer 8

4 - Cystoscopy

Question 9

Which of the following is the first line imaging for prostate cancer?

1 - CT
2 - Transrectal ultrasound-guided (TRUS) biopsy.
3 - Multiparametric MRI
4 - X-ray

Answer 9

3 - Multiparametric MRI

Used to be TRUS, but this can cause:

• sepsis: 1% of cases
• pain: lasting >= 2 weeks in 15% and severe in 7%
• fever: 5%
• haematuria and rectal bleeding

Question 10

What is often the most common location for metastasis in prostate cancer?

1 - bones
2 - liver
3 - lymph nodes
4 - GIT

Answer 10

1 - bones

Question 11

A PSA greater than what would automatically trigger the request for a bone scan?

1 - >3
2 - >10
3 - >20
4 - >40

Answer 11

3 - >20

Question 12

Are the following attributable to the histology of prostate cancer or benign glands?

1 - basal cells
2 - small glands with oval lumens
3 - small glands arranged back to back with stroma

Answer 12

• prostate cancer
• benign tissue has complex branching lumens with papillary infoldings

Question 13

Which scoring system is used to grade prostate cancer?

1 - MRC score
2 - Wells score
3 - Dukes criteria
4 - Glaeson score

Answer 13

4 - Glaeson score
-highest score is 10
- lowest score is 6

Question 14

The epithelial cells of the prostate produce prostate-specific antigen (PSA). PSA is a glycoprotein that is secreted in the semen, with a small amount entering the blood. Its enzymatic activity helps thin the thick semen into a liquid consistency after ejaculation. It is specific to the prostate only and ranges from 2.5-6.5. What test is performed in a patients who have a PSA of 20?

1 - prostate biopsy
2 - bone scan
3 - prostatectomy
4 - all of the above

Answer 14

4 - all of the above

Question 15

The epithelial cells of the prostate produce prostate-specific antigen (PSA). PSA is a glycoprotein that is secreted in the semen, with a small amount entering the blood. Its enzymatic activity helps thin the thick semen into a liquid consistency after ejaculation. It is specific to the prostate only and ranges from 2.5-6,5. What does a PSA of >50 often suggest?

1 - terminal cancer
2 - bladder involvement
3 - lymph node involvement
4 - all of the above

Answer 15

3 - lymph node involvement
- PSA >100 suggest advanced prostate cancer

Question 16

Which of the following are treatment options for a patient with T1/T2 prostate cancer?

1 - conservative: active monitoring & watchful waiting
2 - radical prostatectomy
3 - radiotherapy: external beam and brachytherapy targeting prostate
4 - all of the above

Answer 16

4 - all of the above

Treatment decides on patients wishes and what will give the best outcomes

Question 17

Which of the following are treatment options for a patient with T3/T4 prostate cancer?

1 - hormonal therapy
2 - radical prostatectomy
3 - radiotherapy
4 - all of the above

Answer 17

4 - all of the above

Question 18

In prostate cancer, what us a common complication of Prostatectomy?

1 - infertility
2 - erectile dysfunction
3 - fistula between urethra and colon
4 - bladder infection

Answer 18

2 - erectile dysfunction

Question 19

In prostate cancer, what us a common complication of radiotherapy and brachytherapy?

1 - infertility
2 - erectile dysfunction
3 - fistula between urethra and colon
4 - proctitis

Answer 19

4 - proctitis

Inflammation of the lining of the rectum

These treatments can also increase the risk of other cancer such as bladder, colon, and rectal

Question 20

All of the following are options for patients with prostate cancer:

Curative
- Radical Prostatectomy
- Prostate brachytherapy (radiotherapy inserted into the prostate)

Palliative
- Androgen deprivation therapy
- Chemotherapy

Question 21

Are androgen deprivation therapies gonadotropin hormone-releasing hormone (GnRH) agonists or antagonists being used to treat metastatic prostate cancer?

Answer 21

• both

GnRH agonist reduce LG levels, that eventually will lower testosterone

GnRH antagonists also lower testosterone, but through a different mechanism

Question 22

Which of the following is NOT a common side effect of androgen deprivation therapies gonadotropin hormone-releasing hormone (GnRH) agonists and antagonists?

1 - hot flushes
2 - weight loss
3 - mood changes
4 - impotence
5 - loss of bone mineral density

Answer 22

2 - weight loss

Typically causes weight gain

Question 23

Degarelix (Firmagon) is hormone therapy used to treat prostate cancer. What is the mechanism of action of this medication?

1 -gonadotropin hormone-releasing hormone (GnRH) agonists
2 - gonadotropin hormone-releasing hormone (GnRH) antagonists
3 - testosterone antagonist
4 - leutenising hormone inhibitor

Answer 23

2 - gonadotropin hormone-releasing hormone (GnRH) antagonists

Results in lower LH and testosterone

Typically used in patients with metastatic disease

Question 24

The drug goserlin is hormone therapy used to treat prostate cancer. What is the mechanism of action of this medication?

1 -gonadotropin hormone-releasing hormone (GnRH) agonists
2 - gonadotropin hormone-releasing hormone (GnRH) antagonists
3 - testosterone antagonist
4 - leutenising hormone inhibitor

Answer 24

1 -gonadotropin hormone-releasing hormone (GnRH) agonists

Initially increases GnRH and subsequently LH and testosterone
Then desensitises GnRH, which results in lower LH and testosterone

Typically used in patients with metastatic disease

Question 25

Goserlin is hormone therapy used to treat prostate cancer that is a leutenising hormone inhibitor. What is the important adverse event that can happen shortly after prescribing this medication? 1 - tumour flare due to a temporary increase in LD 2 - tumour flare due to a reduction in LH 3 - rectal cancer due to seeding 4 - urethral obstruction due to tumour growth

Answer 25

1 - tumour flare due to a temporary increase in GnRH and LH This only lasts a few weeks Cyproterone acetate, a steroidal anti-androgen can be prescribed to reduce the risk of tumour flare by blocking dihydrotestosterone (testosterone precursor)

Question 26

Goserlin is hormone therapy used to treat prostate cancer by inhibiting leutenising hormone, and subsequently reducing testosterone. How often is this drug given? 1 - orally every 4 or 12 weeks 2 - IV every 4 or 12 weeks 3 - SC every 4 or 12 weeks 4 - any of the above, patient preference

Answer 26

3 - SC every 4 or 12 weeks Placed just under the skin

Question 27

Goserlin is hormone therapy used to treat prostate cancer by inhibiting leutenising hormone, and subsequently reducing testosterone given SC every 4 or 12 weeks. Which of the following is a common side effect of this drug? 1 - tumour flare 2 - hot flushes and sweats 3 - erectile dysfunction 4 - skin issues 5 - fatigue and hyperglycaemia 6 - all of the above

Answer 27

6 - all of the above

Question 28

In a patient with organ confined PSA of <20 that is <70 y/o, which of the following would they be be offered or receive? 1 - Robotic assisted laparoscopic radical prostatectomy 2 - Androgen deprivation therapy 3 - Radiotherapy 4 - Brachytherapy 5 - all of the above

Answer 28

4 - all of the above - depends on the patients needs

Question 29

In a patient with organ confined PSA of <20 aged between 70-79 y/o, which of the following would they be be offered or receive? 1 - Active Surveillance 2 - Brachytherapy 3 - Androgen deprivation therapy 4 - Radiotherapy 5 - all of the above

Answer 29

5 - all of the above - they just don't have a prostatectomy

Question 30

In a patient with organ confined PSA of <20 aged between >80 y/o, which of the following would they be be offered or receive? 1 - Watchful waiting 2 - Androgen deprivation therapy 3 - Radiotherapy 4 - all of the above

Answer 30

4 - all of the above

Question 31

In a patient with locally advanced prostate cancer and a PSA 20-100, what is the management for all ages? 1 - Active Surveillance 2 - Androgen deprivation therapy 3 - Radiotherapy 4 - all of the above

Answer 31

4 - all of the above - this is the same if the patient has metastatic cancer, but instead they just receive chemotherapy in addition

Question 32

According to NICE, what is the level of prostate specific antigen that would require a 2-week referral in a 50-69 y/o male? 1 - >3 2 - >10 3 - >20 4 - >40

Answer 32

1 - >3 This value or an abnormal DRE examination

Question 33

Although PSA is used to identify those at risk of prostate cancer it is not the best marker, as other things can cause a rise in PSA. All of the following can cause a rise in PSA, EXCEPT which one? 1 - benign prostatic hyperplasia (BPH) 2 - prostatitis and urinary tract infection 3 - smoking 4 - ejaculation (ideally not in the previous 48 hours) 5 - vigorous exercise (ideally not in the previous 48 hours) 6 - urinary retention 7 - instrumentation of the urinary tract

Answer 33

3 - smoking

Question 34

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count? 1 -dexamethasone 2 - granulocyte colony stimulating factors (GCSF) 3 - blood transfusion 4 - frozen WBCs

Answer 34

2 - granulocyte colony stimulating factors (GCSF)