Treatment of Locally Advanced Prostate Cancer Flashcards
Topic: Treatment of Locally Advanced Prostate Cancer
Statement: Currently, no consensus exists regarding the optimal management of locally advanced prostate cancer.
Clinical Vignette
A 60-year-old male is diagnosed with locally advanced prostate cancer. He seeks your opinion on the best treatment approach. What should you tell him about the current consensus on managing his condition?
Options
A. Surgery is the universally accepted best treatment option
B. Radiation therapy is the only recommended treatment
C. There’s a definitive consensus on the optimal treatment
D. No consensus exists on the optimal treatment
Correct Answer
D. No consensus exists on the optimal treatment
Explanation
A: Surgery may not be suitable for all cases of locally advanced prostate cancer.
B: Radiation therapy alone may not be enough for comprehensive management.
C: Contrary to this choice, no universal consensus exists on the optimal treatment.
D: The current state of practice does not have a consensus on the optimal treatment for locally advanced prostate cancer.
Memory Tool
Remember NCO for No Consensus Optimal when thinking of treatment options for locally advanced prostate cancer.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Being aware that no consensus exists aids in having a nuanced discussion with patients about treatment options, benefits, and risks.
Topic: Treatment of Locally Advanced Prostate Cancer
Statement: Risk assessment is best performed by a combination of serum PSA level, T stage, cancer grade, and extent of cancer on biopsy.
Clinical Vignette
A 67-year-old male patient comes to your clinic for an evaluation of an elevated PSA level of 15 ng/mL. He has no urinary symptoms but is concerned about prostate cancer. You perform a digital rectal examination, noting a firm, irregular prostate. A biopsy reveals a Gleason score of 8. What is the most appropriate method for risk assessment in this patient?
Options
A. Serum PSA level only
B. Gleason score only
C. Serum PSA level and Gleason score
D. Serum PSA level, T stage, cancer grade, and extent of cancer on biopsy
Correct Answer
D. Serum PSA level, T stage, cancer grade, and extent of cancer on biopsy
Explanation
A: Relying solely on the serum PSA level may miss other significant risk factors.
B: Gleason score alone is not sufficient for comprehensive risk assessment.
C: While both PSA and Gleason score are important, they’re not enough for a full assessment.
D: The best approach for risk assessment combines serum PSA level, T stage, cancer grade, and extent of cancer on biopsy.
Memory Tool
Think of PTEC as a mnemonic for PSA, T stage, Extent, and Cancer grade.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Understanding comprehensive risk assessment is crucial for determining appropriate treatment options and outcomes in locally advanced prostate cancer.
Clinical Vignette
A 62-year-old man presents with a PSA level of 12 ng/mL and a Gleason score of 7. You’re considering additional imaging studies to evaluate high-risk features. How useful would imaging be in identifying such features?
Options
A. Highly effective
B. Moderately effective
C. Limited effectiveness
D. Not effective at all
Correct Answer
C. Limited effectiveness
Explanation
A: Imaging is not highly effective in identifying high-risk features for treatment failure.
B: Imaging has a limited role, making it less than moderately effective.
C: Imaging plays a limited role in identifying patients with high-risk features for whom local therapy may fail.
D: Although limited, imaging does have some role and is not completely ineffective.
Memory Tool
Remember LIT for Limited Imaging in Therapy failure risk.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Understanding the limitations of imaging in evaluating high-risk features is essential for effective patient management.
Topic: Definition of Advanced Prostate Cancer
Statement: Features other than clinical T stage most often contribute to the identification of men with advanced disease and a concomitant increased risk for failure after primary therapy.
Clinical Vignette
A 58-year-old male is diagnosed with prostate cancer. His clinical T stage is T2. What other factors should you consider to accurately assess his risk for disease progression?
Options
A. Only consider clinical T stage
B. Serum PSA level and extent of cancer on biopsy
C. Family history and age
D. All of the above
Correct Answer
B. Serum PSA level and extent of cancer on biopsy
Explanation
A: Relying solely on clinical T stage is insufficient for a comprehensive risk assessment.
B: Features other than clinical T stage, such as serum PSA level and extent of cancer on biopsy, contribute to identifying men with advanced disease.
C: While these are important factors, they are not the most often contributing features in identifying advanced disease.
D: All of the above would include clinical T stage, which is not the most contributing factor in this case.
Memory Tool
For advanced disease risk, don’t just look at T, peek at PSA and Biopsy too. (PTB)
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Recognizing that factors other than clinical T stage contribute to advanced disease risk is essential for effective management.
Topic: Contemporary Risk Assessment
Statement: The most important pathologic criteria predicting prognosis after radical prostatectomy are Gleason score, surgical margin status, and presence of non–organ-confined disease.
Clinical Vignette
You perform a radical prostatectomy on a 65-year-old male with prostate cancer. Postoperatively, what pathologic criteria are most important for predicting his prognosis?
Options
A. Gleason score only
B. Gleason score and surgical margin status
C. Gleason score, surgical margin status, and lymph node involvement
D. Gleason score, surgical margin status, and presence of non–organ-confined disease
Correct Answer
D. Gleason score, surgical margin status, and presence of non–organ-confined disease
Explanation
A: Gleason score alone is insufficient for a full risk assessment.
B: Both Gleason score and surgical margin status are important, but not comprehensive.
C: Lymph node involvement is not listed as one of the most important criteria.
D: The most important pathologic criteria for predicting prognosis are Gleason score, surgical margin status, and presence of non–organ-confined disease.
Memory Tool
Think GSM-N for Gleason, Surgical Margin, and Non–organ-confined disease.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Knowing the most important pathologic criteria helps in accurately predicting postoperative prognosis and guiding further treatment.
Topic: Trends in Incidence and Treatment
Statement: Within the Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), Cooperberg et al. observed a significant decrease in the fraction of men presenting with high-risk disease characteristics, from 40.9% in 1989 to 1990 to 14.8% in 2001 to 2002.
Clinical Vignette
You’re attending a urology conference, and the topic of changes in prostate cancer incidence comes up. What trend has been observed in the presentation of high-risk prostate cancer according to the CaPSURE study?
Options
A. An increase in high-risk cases
B. No significant change
C. A decrease in high-risk cases
D. Fluctuating trends
Correct Answer
C. A decrease in high-risk cases
Explanation
A: Contrary to this, the CaPSURE study showed a decrease in high-risk cases.
B: The study did indicate a significant change, specifically a decrease.
C: CaPSURE observed a decrease in men presenting with high-risk disease characteristics.
D: The study specifically noted a decrease, not fluctuating trends.
Memory Tool
Remember CaPSURE CAPTURED a Decrease to recall the trend in high-risk cases.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Awareness of epidemiological trends helps in resource allocation and understanding the changing landscape of prostate cancer.
Topic: Natural History
Statement: Men with high-risk prostate cancer, including those with locally advanced disease, are at significant risk for disease progression and disease-specific death if left untreated.
Clinical Vignette
A 55-year-old male is diagnosed with high-risk prostate cancer but wishes to avoid treatment due to personal reasons. What is the risk for this patient if he remains untreated?
Options
A. Low risk for disease progression
B. Moderate risk for disease progression
C. High risk for disease progression and disease-specific death
D. Uncertain risk due to individual variability
Correct Answer
C. High risk for disease progression and disease-specific death
Explanation
A: High-risk prostate cancer left untreated has a high risk for disease progression.
B: The risk is significant and not just moderate.
C: Men with high-risk prostate cancer are at a significant risk for disease progression and disease-specific death if untreated.
D: While individual variability exists, high-risk cases are generally at significant risk if left untreated.
Memory Tool
Think High-Risk = High Stakes to remember the outcome of untreated high-risk prostate cancer.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Understanding the high stakes involved in untreated high-risk prostate cancer is critical for patient counseling.
Topic: Radical Prostatectomy
Statement: In examining all reports, overall survival ranges from 64% to 96% at 5 years, 12.5% to 72% at 10 years, and 20% to 51% at 15 years after treatment.
Clinical Vignette
A 50-year-old man with prostate cancer is considering radical prostatectomy and asks about long-term survival rates. What should you tell him about the overall survival rates after radical prostatectomy?
Options
A. Overall survival is over 90% for up to 15 years
B. Overall survival ranges from 64% to 96% at 5 years, 12.5% to 72% at 10 years, and 20% to 51% at 15 years
C. Overall survival is less than 50% at 5 years
D. Data on long-term survival after radical prostatectomy is inconclusive
Correct Answer
B. Overall survival ranges from 64% to 96% at 5 years, 12.5% to 72% at 10 years, and 20% to 51% at 15 years
Explanation
A: The range of survival is more variable and does not stay over 90% for up to 15 years.
B: This option accurately reflects the range of survival rates at different time intervals after treatment.
C: The lower limit at 5 years is 64%, not less than 50%.
D: Data on long-term survival is available and has been quantified.
Memory Tool
Remember 5-10-15 to recall the three key time intervals for survival rates.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Having accurate survival statistics is crucial for informed decision-making and patient counseling.
Topic: Outcomes of Prostatectomy for Pathologically Advanced Disease
Statement: The presence of focal or established extracapsular extension increases the rate of clinical progression from 7% for organ-confined disease to 18% and 35%, respectively, at 5 years.
Clinical Vignette
A 60-year-old patient underwent a radical prostatectomy, and the pathology report showed established extracapsular extension. What is his risk of clinical progression at 5 years?
Options
A. 7%
B. 18%
C. 35%
D. 50%
Correct Answer
C. 35%
Explanation
A: This percentage is for organ-confined disease, not for cases with established extracapsular extension.
B: 18% is the rate for focal extracapsular extension, not established extracapsular extension.
C: The presence of established extracapsular extension increases the rate of clinical progression to 35% at 5 years.
D: The rate is not as high as 50% for established extracapsular extension.
Memory Tool
For established extracapsular extension, think EE = 35 (Extracapsular Established equals 35% risk).
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Understanding the increased risk associated with extracapsular extension is critical for postoperative management and surveillance.
Topic: Adjuvant Radiation Therapy
Statement: The use of adjuvant RT is associated with a range of BDFS from 50% to 88% at 5 years.
Clinical Vignette
A 62-year-old man who recently underwent radical prostatectomy for prostate cancer is considering adjuvant radiation therapy. What can you tell him about the expected 5-year BDFS rates with adjuvant RT?
Options
A. Below 50%
B. 50% to 88%
C. 90% to 95%
D. Data is inconclusive
Correct Answer
B. 50% to 88%
Explanation
A: The lower limit for BDFS with adjuvant RT is 50%, not below it.
B: The use of adjuvant RT is associated with a BDFS range of 50% to 88% at 5 years.
C: The upper limit is 88%, not as high as 90% to 95%.
D: Data on this topic is available and conclusive.
Memory Tool
Remember RT: 50-88 at 5 to recall the 5-year BDFS rates with adjuvant RT.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Knowledge of BDFS rates is essential for discussing adjuvant treatment options and expectations with patients.
Topic: Radiation Therapy
Statement: Neoadjuvant and concurrent AD appears to be appropriate in high-risk patients undergoing RT.
Clinical Vignette
A 70-year-old man with high-risk prostate cancer is scheduled for radiation therapy. What additional treatment should be considered?
Options
A. Neoadjuvant and concurrent AD
B. Concurrent chemotherapy
C. Adjuvant hormone therapy only
D. No additional treatment is needed
Correct Answer
A. Neoadjuvant and concurrent AD
Explanation
A: Neoadjuvant and concurrent AD is appropriate for high-risk patients undergoing RT.
B: Concurrent chemotherapy is not the standard recommendation for high-risk patients undergoing RT.
C: Adjuvant hormone therapy alone is not the recommendation for these patients.
D: Additional treatment is beneficial in high-risk patients.
Memory Tool
Think High Risk = AD + RT for concurrent Androgen Deprivation and Radiation Therapy.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Combining AD with RT can offer better treatment outcomes for high-risk patients.
Topic: Adjuvant Androgen Deprivation and Radiation Therapy
Statement: Thus a limited period of AD (2 to 4 months) appears to be appropriate for men with intermediate-risk cancers; more prolonged AD may be beneficial for those with high-risk disease characteristics.
Clinical Vignette
You have a 55-year-old patient with intermediate-risk prostate cancer. How long should he be on androgen deprivation therapy if he’s also undergoing radiation therapy?
Options
A. 1 month
B. 2 to 4 months
C. 6 to 12 months
D. Indefinitely
Correct Answer
B. 2 to 4 months
Explanation
A: A 1-month period is too short for intermediate-risk patients.
B: A limited period of 2 to 4 months of AD is appropriate for men with intermediate-risk cancers.
C: Longer periods are recommended for high-risk patients, not intermediate-risk.
D: Indefinite AD is not recommended for intermediate-risk patients.
Memory Tool
For intermediate risk, remember AD: 2-4 to recall the recommended months for AD.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Tailoring the duration of AD according to risk stratification optimizes patient outcomes.
Topic: Androgen Deprivation and Its Timing
Statement: Early AD may improve survival.
Clinical Vignette
A 63-year-old male with newly diagnosed prostate cancer is discussing treatment options. What is the benefit of early androgen deprivation therapy?
Options
A. No significant benefit
B. May worsen survival
C. May improve survival
D. Benefits are inconclusive
Correct Answer
C. May improve survival
Explanation
A: Early AD has been shown to improve survival, not to have no benefit.
B: There is no evidence to suggest that early AD may worsen survival.
C: Early AD may improve survival in prostate cancer patients.
D: Benefits are not inconclusive; they point towards improved survival.
Memory Tool
Think Early AD = Early Advantage to remember the benefit of early AD.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
The timing of androgen deprivation can influence survival outcomes, making it an important consideration in treatment planning.
Topic: Alternative Methods of Androgen Manipulation
Statement: Alternative methods of androgen manipulation (antiandrogen, intermittent) remain investigational.
Clinical Vignette
A 68-year-old male patient is keen on exploring alternative methods of androgen manipulation for his prostate cancer. What should you inform him about these methods?
Options
A. Widely accepted and proven effective
B. Only effective in low-risk patients
C. Remain investigational
D. Not recommended under any circumstance
Correct Answer
C. Remain investigational
Explanation
A: These methods are not widely accepted as proven effective yet.
B: The investigational status applies across the risk spectrum, not just to low-risk patients.
C: Alternative methods of androgen manipulation like antiandrogen and intermittent therapies remain investigational.
D: They are not outright rejected, but they are still under investigation.
Memory Tool
When considering alternative AD, think I for Investigational.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Being up-to-date on the investigational status of alternative treatments is vital for informed patient counseling.
Topic: Trends in Incidence and Treatment
Statement: Overall, the presence of clinically advanced disease (i.e., T3-4) decreased from 11.8% to 3.5%.
Clinical Vignette
You’re discussing recent trends in prostate cancer with your colleagues. What has happened to the incidence of clinically advanced disease (T3-4) over time?
Options
A. Increased to 11.8%
B. Decreased to 3.5%
C. Remained stable
D. Fluctuated without a clear pattern
Correct Answer
B. Decreased to 3.5%
Explanation
A: The incidence actually decreased, not increased.
B: The presence of clinically advanced disease (T3-4) has decreased to 3.5%.
C: The incidence did not remain stable; it decreased.
D: There is a clear pattern of decrease, not fluctuation.
Memory Tool
Remember T3-4 to 3.5 to recall the decreased incidence of clinically advanced disease.
Reference
Campbell’s Urology, 12th Edition, Chapter 159
Rationale
Being aware of trends in disease incidence helps inform screening and treatment strategies.
