Westra: Prostate Screening

Question 1

what is the most common age group at diagnosis of prostate cancer?

Answer 1

65-74 yrs old

Question 2

men in the U.S. have a ___ in ____ lifetime risk of being diagnosed with prostate cancer

Answer 2

1/6

Question 3

what is the most common cancer detected in men?

Answer 3

prostate cancer

Question 4

what RACE has a higher incidence rate for prostate cancer?

Answer 4

AFRICAN AMERICAN MEN

Question 5

what RACE has a higher death rate due to prostatic cancer?

Answer 5

AFRICAN AMERICAN MEN

Question 6

____ and ____ are the only risk factors incorporated into the current screening recommendations.

Answer 6

Race, Family Hx (men w/ father or brother with prostate cancer are 2x as likely to develop prostate cancer)

Question 7

T or F: male relatives of breast cancer patients have a higher incidence of prostate cancer

Answer 7

True. BRCA2 more associated

Question 8

what dietary choices can increase risk of prostate cancer?

Answer 8

Folic acid. (Diary and calcium….)

Question 9

**what hormonal levels cause an increased risk of prostatic cancer in men?

Answer 9

high plasma testosterone levels

Question 10

what occupational/chemical exposure increases risk of prostate cancer?

Answer 10

Dioxin “agent orange” (Vietnam War era)

Question 11

what is a protective agent for prostate cancer in the diet?

Answer 11

Folate

Question 12

what exactly is a PSA?

Answer 12

Protein specific antigen. it is a blood test used to measure a protein made by prostate cells. less than 4 ng/ml normal. 4-10 borderline. greater than 10 high

Question 13

PSA _____ = reflects relationship between PSA level and size of gland measured by transrectal ultrasound

Answer 13

Density

Question 14

PSA _____ = measures how quickly PSA level rises over period of time.

Answer 14

Velocity. a change of >0.75 ng/ml rise in one year is signficant

Question 15

if a Digital Rectal Exam (DRE) is abnormal, what is the recommended next step?

Answer 15

Trans-rectal Ultrasound (TRUS)

Question 16

when would you perform a prostate biopsy?

Answer 16

abnormal palpated by DRE. PSA elevated based on age-adjusted range. PSA velocity >0.75. previous negative biopsy but continually increasing PSA.

Question 17

What is the TX strategy for a patient who has less aggressive tumors, greater than 70 with co-existent illnesses, potential treatment side effects, palliative therapy? (A) Active Surveliance (B) Surgery (C) Cryosurgery (D) Chemotherapy (E) Hormonal therapy

Answer 17

A

Question 18

What does a radical prostatectomy consist of?

Answer 18

removal of prostate and seminal vesicles

Question 19

what are side effects of surgery?

Answer 19

impotence (1/36) and urinary incontinence (1/81)

Question 20

when should you perform surgery?

Answer 20

if less than 70yrs old, only if cancer HAS NOT spread outside of the prostate gland.

Question 21

what exactly is Cryosurgery?

Answer 21

destroys prostate CA by freezing the prostate tissue with cryoprobes

Question 22

Brachytherapy- what is it?

Answer 22

inserting radiation seeds into prostate under TRUS. (percutaneous perineal interstitial seed I125 or Palladium 123)

Question 23

when is chemotherapy for prostate cancer use? examples of drugs?

Answer 23

for progressive disease or recurrent after treatment. Docetaxel combined with prednisone. cabazitaxel

Question 24

what treatment strategy would you consider for 55 male with PSA 6, normal DRE and prostate biopsy positive for adenocarcinoma? (1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection

Answer 24

Radical Prostatectomy! He’s only 55.

Question 25

what treatment strategy would you consider for 78 yr old male with PSA 15, nodular prostate and positive prostate biopsy?
(1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection

Answer 25

Radiation therapy! will he get bone metastatsis??

Question 26

what treatment strategy would you consider for 74 yr old male with severe oxygen dependent COPD with hesitancy and enlarged prostate on DRE. opted for PSA, declined biopsy?

(1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection

Answer 26

Active surveillance.

comorbidities and over 70yrs old

Question 27

what treatment strategy would you consider for a 94 yr old male with firm nodular prostate and urinary retention. opted for PSA 100?
(1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection

Answer 27

Bilateral orchiectomy and transurethral resection

Question 28

if they had local disease, what are the surveillance recommendations?

Answer 28

DRE annually, PSA q 6-12mo for 5 yrs, then annually