Risk

Question 1

What is PSA?

Answer 1

serine protease 34KD glycoprotein
pre pro PSA to pro PSA
free PSA, bound to ACT, bound to AMG
activated by AR

Question 2

BRCA study Embrace Eur Urol

Impact study eur urol 2019

Answer 2

2-5 x higher risk of developing prostate cancer and more aggressive BRCA 2 than general population

Impact
More higher risk PC in BRCA 2 carriers vs mom carriers

Question 3

Lifetime risk diagnosis ethnicity
white
black
asian

Answer 3

1/8 to 1/9 white
1/4 black men - afra caribbean relative incidence 1.6 compared to white men
1/13 Asian

Question 4

Lifetime risk dying ethnicity

Answer 4

1/24 white man

1/12 black

Question 5

post morten studies prostate cancer
50 year olds
80 year olds

Answer 5

30% 50 year olds

70% of 80 year olds

Question 6

median age diagnosis

Answer 6

66 yo

Question 7

% prostate cancer occuring in over 75

% diagnosed in over 65

Answer 7

71%

75%

Question 8

% hereditary prostate cancer

Answer 8

9%

Question 9

definition hereditary prostate cancer

Answer 9

3+ affected relative or 2+ with early onset disease less than 55 yo

Question 10

gene mutations associated

Answer 10

single defect chronosome 1q
8p
13q-BRCA 2

Question 11

relative risk with 1st degree relative
one 1st degree
two 1st degree
hereditary

Answer 11

2x
4x
5x

Question 12

relative risk with 1st degree relative
one 1st degree
two 1st degree
hereditary

Answer 12

2x
4x
5x

Question 13

REDUCE study

Answer 13

lower risk of low grade PCA with obesity, higher risk of high grade PCA
lower circulating androgens - causing lower PSA
higher free IGF-1 levels
no association LDL HDL cholesterol levels
statins do not protect against PCa

Question 13

prostate cancer and obesity

Answer 13

lower risk of low grade PCA with obesity, higher risk of high grade PCA
lower circulating androgens - causing lower PSA
higher free IGF-1 levels
no association LDL HDL cholesterol levels
statins do not protect against PCa

Question 14

relationship vitamin D with prostate cancer

Answer 14

u shaped relationship

polymorphisms of vit d recetpros

Question 15

testosterone risk with PCa

Answer 15

no extra risk when given to hypogonadal men

Question 16

5ARi and prostate cancer evidence

Answer 16

PCPT trial Thompson NEJM

proposed lower incidence of Pca but higher risk of high grade PCA

Question 17

gene fusions in PCA

Answer 17

most commonly involves fusion of TMPRSS2 to members of ETS family
promotes genes under androgenic control

Question 18

other genes implicated in PCa 4

Answer 18

cell cycle genes
DNA repair genes
tumour suppressor genes
hormonal response genes

Question 19

REDUCE

Answer 19

2010
reduction of dutasteride of prostate cancer events
RRR 22% of prostate cancer
higher incidence of high grade prostate cancer

Question 20

PCPT trial

Answer 20

thompson NEJM 2003
finasteride vs placebo 7 years
25% RRR incidence prostate cancer 24% vs 18%
higher incidence high grade prostate cancer 6.4% vs 5.1%

Question 21

SELECT trial vitamin E

Answer 21

Klein 2011
vitamin E increased incidence prostate cancer
combination treatment had no effect