Prostate cancer Flashcards
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
2 - 170 cases per 100,000
At what age does the incidence of prostate cancer peak at?
1 - >30
2 - >50
3 - >60
4 - >70
4 - >70
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)
4 - Alcohol
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
2 - APC
Common in colon cancer
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
7 - penile discharge
- 5 year survival is 98%
Which part of the prostate is predominately affected?
1 - central zone
2 - peripheral zone
3 - transitional zone
4 - urethral zone
2 - peripheral zone
The transitional zone is commonly affected by BPH, which can also cause lower urinary tract symptoms
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
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.
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
4 - Cystoscopy
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
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
What is often the most common location for metastasis in prostate cancer?
1 - bones
2 - liver
3 - lymph nodes
4 - GIT
1 - bones
A PSA greater than what would automatically trigger the request for a bone scan?
1 - >3
2 - >10
3 - >20
4 - >40
3 - >20
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
- prostate cancer
- benign tissue has complex branching lumens with papillary infoldings
Which scoring system is used to grade prostate cancer?
1 - MRC score
2 - Wells score
3 - Dukes criteria
4 - Glaeson score
4 - Glaeson score
-highest score is 10
- lowest score is 6
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
4 - all of the above
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
3 - lymph node involvement
- PSA >100 suggest advanced prostate cancer
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
4 - all of the above
Treatment decides on patients wishes and what will give the best outcomes
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
4 - all of the above
In prostate cancer, what us a common complication of Prostatectomy?
1 - infertility
2 - erectile dysfunction
3 - fistula between urethra and colon
4 - bladder infection
2 - erectile dysfunction
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
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
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
Are androgen deprivation therapies gonadotropin hormone-releasing hormone (GnRH) agonists or antagonists being used to treat metastatic prostate cancer?
- both
GnRH agonist reduce LG levels, that eventually will lower testosterone
GnRH antagonists also lower testosterone, but through a different mechanism
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
2 - weight loss
Typically causes weight gain
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
2 - gonadotropin hormone-releasing hormone (GnRH) antagonists
Results in lower LH and testosterone
Typically used in patients with metastatic disease
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
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
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
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)
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
3 - SC every 4 or 12 weeks
Placed just under the skin
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
6 - all of the above
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
4 - all of the above
- depends on the patients needs
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
5 - all of the above
- they just don’t have a prostatectomy
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
4 - all of the above
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
4 - all of the above
- this is the same if the patient has metastatic cancer, but instead they just receive chemotherapy in addition
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
1 - >3
This value or an abnormal DRE examination
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
3 - smoking
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
2 - granulocyte colony stimulating factors (GCSF)
