Prostate cancer

Question 1

List risk factors for prostate cancer

Answer 1

age, esp >50
race, more aggressive tumors in African Americans
FH/ genetics
high fat diet

Question 2

The majority of prostate cancers arise in the _______ zone

Answer 2

peripheral

Question 3

Where is the most common site of metastasis of prostate cancer

Answer 3

bone

Question 4

What does the Gleason score assess?

Answer 4

degree of glandular differentiation/ growth pattern of the tumor in relation to prostatic stroma

Question 5

How does prostate cancer usually present?

Answer 5

often asymptomatic
if locally advanced- may have ED, pelvic pain
if advanced- may have bone pain, neuro sx, fractures

Question 6

What could cause an elevated PSA

Answer 6

prostate cancer
inflammation
infection
BPH
ejaculation
trauma/ exercise

Question 7

What patients may be candidates for active surveillance of prostate cancer?

Answer 7

Low gleason score, low risk disease, >10 yrs remaining life expectancy

Question 8

What is the ultimate goal of active surveillance for prostate cancer?

Answer 8

cure

Question 9

Describe radical prostatectomy

Answer 9

removal of prostate, capsule, seminal vesicles, ampulla, vas, fascia between seminal vesicles and bladder.

Question 10

Describe outcomes from radical prostatectomy

Answer 10

~75-90% 10-15 year prostate cancer-specific survival in patients who are good candidates

Question 11

What are short term complications of radiation therapy for prostate cancer

Answer 11

diarrhea, rectal pain/ bleeding, dysuria, frequency, nocturia

Question 12

What are long term complications of radiation therapy for prostate cancer

Answer 12

Most common: impotence, incontinence.

Other: proctitis, rectal ulcers, chronic cystitis, urinary stricture

Question 13

Is surgery vs radiation more effective in curing prostate cancer? What factors do men use to chose treatment?

Answer 13

Neither is clearly better in local disease

given concerns over the long-term cancer control rates with radiation therapy, younger men often choose surgery.
lower risks during treatment (complication from anesthesia, cardiac risk factors, etc.) often prompt older individuals to choose radiation

Question 14

Androgen deprivation therapy is reserved for men with _______

Answer 14

radiographic metastasis

Question 15

What are some methods of androgen deprivation therapy

Answer 15

 Orchiectomy
 LGnRH-agonist 
 LHRH GnRH-antagonist
 Estrogen
 Anti-androgens

Question 16

Eventually, all patients develop ______ resistant prostate cancer

Answer 16

castrate

Question 17

A hereditary deficiency of ________ is associated with a lower risk of prostate cancer

Answer 17

5a-reductase

prostate cancer is driven by androgens

Question 18

What are features of prostatic intraepithelial neoplasia

Answer 18

• larger nuclei, prominent nucleoli
• still contained within the basal cells and basement membrane
• does have many of the molecular changes seen in invasive carcinoma

Question 19

What are the histologic features of prostate adenocarcinoma

Answer 19

• loss of basal cell layer
• small, round, crowded glands
• enlargement of cells
• prominent nucleoli

Question 20

What are some advantages of surgery over radiation for prostate cancer

Answer 20

Pathologic staging
Minimal rectal toxicity
Can perform radiation if cancer relapses
No secondary malignancies

Question 21

What are some advantages of radiation over surgery for prostate cancer

Answer 21

More effective if used in combination with ADT
No surgical complications
Able to treat pelvic lymph nodes
Less urinary incontinence

Question 22

In what patients might ADT be used as a primary treatmetn

Answer 22

• elderly or multiple co-morbidities
• significant likelihood of micro-metastasis

NOT a curative treatment