Quiz
ON12 Prostate Cancer
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Questions in this quiz (14)
1Epidemiology:
Median age at diagnosis is [blank_start]66[blank_end] years.
[blank_start]100%[blank_end] 5 year survival rate with local or regional disease
[blank_start]28.7%[blank_end] 5 year survival rate with distant disease
95% are [blank_start]adenocarcinoma[blank_end](cancer that starts in the mucous glands in epithelial tissue).
In New Zealand…
[blank_start]Most common[blank_end] cancer in men (3000 new cases/year, 600 deaths/year).- A66
- B100%
- C28.7%
- Dadenocarcinoma
- EMost common
2Which of these is NOT a risk factor for prostate cancer?
- AMale
- BAge >40
- CBlack (race)
- DFamily history
- EAlcohol consumption
3There is controversy with screening for prostate cancer as there is no clear evidence of mortality benefit with screening.
- ATrue
- BFalse
4Screening methods:
- Digital rectal exam (circa 1900s).
[blank_start]Cheap, safe, easy[blank_end] BUT not [blank_start]sensitive[blank_end], poor interobserver reliability, poor [blank_start]compliance[blank_end]
- PSA blood test (prostate specific antigen)
Low [blank_start]specificity[blank_end]. Many other causes (BPH, acute [blank_start]prostatitis[blank_end], urinary [blank_start]retention[blank_end],benign prostatic [blank_start]hypertrophy[blank_end]).- ACheap, safe, easy
- Bsensitive
- Ccompliance
- Dspecificity
- Eprostatitis
- Fretention
- Ghypertrophy
5Select ALL the symptoms of prostate cancer which indicate advanced disease.
- APainful urination
- BErectile dysfunction
- CUrinary hesitance
- DUrinary retention
- EHematuria
- FWeight loss
- GBack pain
- HLower extremity oedema
- IAnemia
6Diagnosis
History and physical exam.
DRE and PSA.
TRUS - [blank_start]transrectal ultrasound[blank_end] - if one of above positive).
[blank_start]Biopsy[blank_end] (confirmative)- Atransrectal ultrasound
- BBiopsy
7Staging:
Stage A - [blank_start]Occult or palpable[blank_end]
Stage B -[blank_start]Confined to the prostate[blank_end]
Stage C - [blank_start]Localised to periprostatic area[blank_end]
Stage D - Metastatic disease
[blank_start]T0N0M0[blank_end] (non-palpable)
[blank_start]T1[blank_end] - Not palpable or visible by imaging
[blank_start]T2[blank_end] - Confined within prostate
[blank_start]T3[blank_end] - Extends through capsule
[blank_start]T4[blank_end] - Fixed or invades adjacent structures (other than seminal vesicles)- AOccult or palpable
- BConfined to the prostate
- CLocalised to periprostatic area
- DT0N0M0
- ET1
- FT2
- GT3
- HT4
8Gleason Score:
Histologic grade of tumor. Calculated based on dominant [blank_start]histological[blank_end] grades. Scores range from 1 = well [blank_start]differentiated[blank_end] healthy tissue, to 5 = very [blank_start]poorly[blank_end] differentiated abnormal tissue. Gleason score = sum of [blank_start]two most common[blank_end] pattern grades ([blank_start]2 to 10[blank_end]). Higher is worse.- Ahistological
- Bdifferentiated
- Cpoorly
- Dtwo most common
- E2 to 10
9Factors influencing prognosis:
Extent of [blank_start]tumor[blank_end]
Histological [blank_start]grade[blank_end] of tumor
Patient’s [blank_start]age and health[blank_end]
[blank_start]Molecular markers[blank_end] (Bcl-2, Bax, Ki67, p53, p27, E-cadherin, Microvessel density, DNA ploidy, p16)
PSA level? - Atumor
- Bgrade
- Cage and health
- DMolecular markers
10Initial treatment depends on the stage, Gleason score, presence of symptoms, and life expectancy.
Low risk patients (T1 or T2, GS of [blank_start]2-6[blank_end], PSA<10ng/ml) – excellent survival (10yr):
[blank_start]ObservationRadiation[blank_end]
Radical [blank_start]prostatectomy [blank_end]
Life expectancy <10 years?
Observation
Radiation therapy - A2-6
- Bprostatectomy
- CObservation, radiation
11Nonpharmacological Treatments:
Observation - DRE and PSA performed every [blank_start]6[blank_end] months and biopsy if signs of [blank_start]progression[blank_end]
Radiation - Effective yet complications ([blank_start]hematuria, impotence, diarrhea, cystitis[blank_end])
Radical prostatectom y - Complications: [blank_start]blood loss[blank_end], impotence, [blank_start]incontinence[blank_end], fistula
Bilateral orchiectomy (removal of testes). Need [blank_start]androgen deprivation therapy[blank_end].- A6
- Bprogression
- Chematuria, impotence, diarrhea, cystitis
- Dblood loss
- Eincontinence
- Fandrogen deprivation therapy
12Hormonal Treatment:
Rationale - Androgens stimulate prostate cancer cells to [blank_start]grow[blank_end]. Main androgens are [blank_start]testosterone[blank_end] and dihydrotestosterone (DHT). Most androgens made by [blank_start]testicles[blank_end] but also by adrenal glands. Lowering androgen levels makes prostate cancer cells shrink or grow more [blank_start]slowly[blank_end] but does not cure prostate cancer.
Indication - If cancer cannot be cured by surgery or radiation or [blank_start]remains/relapses[blank_end]... In combination with radiation therapy if high [blank_start]risk of recurrence[blank_end] (high Gleason)... OR before radiation to shrink cancer and make radiation more [blank_start]effective[blank_end] .- Agrow
- Btestosterone
- Ctesticles
- Dslowly
- Eremains/relapses
- Frisk of recurrence
- Geffective
13Pharmacological (hormone) Treatment:
1. LHRH [blank_start]agonists[blank_end] - Reversible method of androgen ablation as effective as orchiectomy. Puts patient at risk for [blank_start]osteoporosis[blank_end]. Drugs: [blank_start]Leuprolide, Goserelin,[blank_end] Triptorelin, Histrelin.
2. GnRH [blank_start]antagonists[blank_end] - Works directly in [blank_start]pituitary[blank_end] to reduce testosterone
3. Antiandrogens - Bind to [blank_start]androgen[blank_end] receptors so androgens cannot. Not used alone, typically with LHRH agonists/removal of testicles. Drugs: [blank_start]Flutamide, Bicalutamide, Nilutamide[blank_end]- Aagonists
- Bosteoporosis
- CLeuprolide, Goserelin,
- Dantagonists
- Epituitary
- Fandrogen
- GFlutamide, Bicalutamide, Nilutamide
14Which of these is not an ADR of androgen lowering therapies?
- AReduced or absent sexual desire
- BErectile dysfunction
- CShrinkage of testicles and penis
- DHot flushes
- EOsteoporosis
- FAnemia
- GLoss muscle mass
- HWeight gain
- IDepression
- JWeight loss
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- User has deleted their subject information Quiz on ON12 Prostate Cancer, created by Deleted user on 09/10/2019.
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