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A. Block E Oncology > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

What is the incidence of prostate cancer?

1 - 17 cases per 100,000
2 - 170 cases per 100,000
3 - 1700 cases per 100,000
4 - 17,000 cases per 100,000

A

2 - 170 cases per 100,000

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2
Q

At what age does the incidence of prostate cancer peak at?

1 - >30
2 - >50
3 - >60
4 - >70

A

4 - >70

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3
Q

Which of the following is NOT a common risk factor for prostate cancer?

1 - Age
2 - Race/ethnicity (highest in Black African ethnicity)
3 - Family history and genetics
4 - Alcohol
5 - Hormonal factors
6 - Environmental factors (exposure to certain chemicals, diet, and lifestyle)

A

4 - Alcohol

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4
Q

Family history and genetics has a role to play as a risk factor in the development of prostate cancer. Which of the following genes, has NOT been associated with prostate cancer?

1 - BRCA1
2 - APC
3 - BRCA2
4 - HOXB13

A

2 - APC

Common in colon cancer

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5
Q

Prostate cancer is the 2nd most common cancer in men and typically affects Afro-Caribbean men more frequently. This can often be asymptomatic early on and only present on a routine check of the prostate. Which of the following is NOT a common symptom associated with prostate cancer?

1 - haematuria
2 - lower urinary tract symptoms (obstruction, hesitancy, retention)
3 - haematospermia (blood in semen)
4 - bone pain with metastasis
5 - flank, groin and back pain
6 - bladder outflow obstruction with AKI
7 - penile discharge

A

7 - penile discharge

  • 5 year survival is 98%
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6
Q

Which part of the prostate is predominately affected?

1 - central zone
2 - peripheral zone
3 - transitional zone
4 - urethral zone

A

2 - peripheral zone

The transitional zone is commonly affected by BPH, which can also cause lower urinary tract symptoms

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7
Q

Which of the following patients would be referred on a 2-week pathway due to the risk of prostate cancer?

1 - 40 y/o with PSA >age related range
2 - 65 y/o elevated PSA, urinary tract symptoms and erectile dysfunction
3 - 50 y/o with abnormal DRE with urinary retention and visible haematuria
4 - 30 y/o with elevated PSA, abnormal DRE and visible haematuria
5 - all patients referred

A

5 - all patients referred

Full NICE referral below:

Consider a prostate‑specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:
any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
erectile dysfunction or
visible haematuria.

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8
Q

Which of the following is typically not part of the diagnosis of prostate cancer?

1 - Elevated serum Prostate Specific Antigen (PSA)
2 - Digital rectal examination: induration, asymmetry, nodule
3 - Prostate biopsy
4 - Cystoscopy

A

4 - Cystoscopy

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9
Q

Which of the following is the first line imaging for prostate cancer?

1 - CT
2 - Transrectal ultrasound-guided (TRUS) biopsy.
3 - Multiparametric MRI
4 - X-ray

A

3 - Multiparametric MRI

Used to be TRUS, but this can cause:

  • sepsis: 1% of cases
  • pain: lasting >= 2 weeks in 15% and severe in 7%
  • fever: 5%
  • haematuria and rectal bleeding
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10
Q

What is often the most common location for metastasis in prostate cancer?

1 - bones
2 - liver
3 - lymph nodes
4 - GIT

A

1 - bones

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11
Q

A PSA greater than what would automatically trigger the request for a bone scan?

1 - >3
2 - >10
3 - >20
4 - >40

A

3 - >20

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12
Q

Are the following attributable to the histology of prostate cancer or benign glands?

1 - basal cells
2 - small glands with oval lumens
3 - small glands arranged back to back with stroma

A
  • prostate cancer
  • benign tissue has complex branching lumens with papillary infoldings
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13
Q

Which scoring system is used to grade prostate cancer?

1 - MRC score
2 - Wells score
3 - Dukes criteria
4 - Glaeson score

A

4 - Glaeson score
-highest score is 10
- lowest score is 6

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14
Q

The epithelial cells of the prostate produce prostate-specific antigen (PSA). PSA is a glycoprotein that is secreted in the semen, with a small amount entering the blood. Its enzymatic activity helps thin the thick semen into a liquid consistency after ejaculation. It is specific to the prostate only and ranges from 2.5-6.5. What test is performed in a patients who have a PSA of 20?

1 - prostate biopsy
2 - bone scan
3 - prostatectomy
4 - all of the above

A

4 - all of the above

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15
Q

The epithelial cells of the prostate produce prostate-specific antigen (PSA). PSA is a glycoprotein that is secreted in the semen, with a small amount entering the blood. Its enzymatic activity helps thin the thick semen into a liquid consistency after ejaculation. It is specific to the prostate only and ranges from 2.5-6,5. What does a PSA of >50 often suggest?

1 - terminal cancer
2 - bladder involvement
3 - lymph node involvement
4 - all of the above

A

3 - lymph node involvement
- PSA >100 suggest advanced prostate cancer

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16
Q

Which of the following are treatment options for a patient with T1/T2 prostate cancer?

1 - conservative: active monitoring & watchful waiting
2 - radical prostatectomy
3 - radiotherapy: external beam and brachytherapy targeting prostate
4 - all of the above

A

4 - all of the above

Treatment decides on patients wishes and what will give the best outcomes

17
Q

Which of the following are treatment options for a patient with T3/T4 prostate cancer?

1 - hormonal therapy
2 - radical prostatectomy
3 - radiotherapy
4 - all of the above

A

4 - all of the above

18
Q

In prostate cancer, what us a common complication of Prostatectomy?

1 - infertility
2 - erectile dysfunction
3 - fistula between urethra and colon
4 - bladder infection

A

2 - erectile dysfunction

19
Q

In prostate cancer, what us a common complication of radiotherapy and brachytherapy?

1 - infertility
2 - erectile dysfunction
3 - fistula between urethra and colon
4 - proctitis

A

4 - proctitis

Inflammation of the lining of the rectum

These treatments can also increase the risk of other cancer such as bladder, colon, and rectal

20
Q

All of the following are options for patients with prostate cancer:

Curative
- Radical Prostatectomy
- Prostate brachytherapy (radiotherapy inserted into the prostate)

Palliative
- Androgen deprivation therapy
- Chemotherapy

A
21
Q

Are androgen deprivation therapies gonadotropin hormone-releasing hormone (GnRH) agonists or antagonists being used to treat metastatic prostate cancer?

A
  • both

GnRH agonist reduce LG levels, that eventually will lower testosterone

GnRH antagonists also lower testosterone, but through a different mechanism

22
Q

Which of the following is NOT a common side effect of androgen deprivation therapies gonadotropin hormone-releasing hormone (GnRH) agonists and antagonists?

1 - hot flushes
2 - weight loss
3 - mood changes
4 - impotence
5 - loss of bone mineral density

A

2 - weight loss

Typically causes weight gain

23
Q

Degarelix (Firmagon) is hormone therapy used to treat prostate cancer. What is the mechanism of action of this medication?

1 -gonadotropin hormone-releasing hormone (GnRH) agonists
2 - gonadotropin hormone-releasing hormone (GnRH) antagonists
3 - testosterone antagonist
4 - leutenising hormone inhibitor

A

2 - gonadotropin hormone-releasing hormone (GnRH) antagonists

Results in lower LH and testosterone

Typically used in patients with metastatic disease

24
Q

The drug goserlin is hormone therapy used to treat prostate cancer. What is the mechanism of action of this medication?

1 -gonadotropin hormone-releasing hormone (GnRH) agonists
2 - gonadotropin hormone-releasing hormone (GnRH) antagonists
3 - testosterone antagonist
4 - leutenising hormone inhibitor

A

1 -gonadotropin hormone-releasing hormone (GnRH) agonists

Initially increases GnRH and subsequently LH and testosterone
Then desensitises GnRH, which results in lower LH and testosterone

Typically used in patients with metastatic disease

25
Q

Goserlin is hormone therapy used to treat prostate cancer that is a leutenising hormone inhibitor. What is the important adverse event that can happen shortly after prescribing this medication?

1 - tumour flare due to a temporary increase in LD
2 - tumour flare due to a reduction in LH
3 - rectal cancer due to seeding
4 - urethral obstruction due to tumour growth

A

1 - tumour flare due to a temporary increase in GnRH and LH

This only lasts a few weeks

Cyproterone acetate, a steroidal anti-androgen can be prescribed to reduce the risk of tumour flare by blocking dihydrotestosterone (testosterone precursor)

26
Q

Goserlin is hormone therapy used to treat prostate cancer by inhibiting leutenising hormone, and subsequently reducing testosterone. How often is this drug given?

1 - orally every 4 or 12 weeks
2 - IV every 4 or 12 weeks
3 - SC every 4 or 12 weeks
4 - any of the above, patient preference

A

3 - SC every 4 or 12 weeks

Placed just under the skin

27
Q

Goserlin is hormone therapy used to treat prostate cancer by inhibiting leutenising hormone, and subsequently reducing testosterone given SC every 4 or 12 weeks. Which of the following is a common side effect of this drug?

1 - tumour flare
2 - hot flushes and sweats
3 - erectile dysfunction
4 - skin issues
5 - fatigue and hyperglycaemia
6 - all of the above

A

6 - all of the above

28
Q

In a patient with organ confined PSA of <20 that is <70 y/o, which of the following would they be be offered or receive?

1 - Robotic assisted laparoscopic radical prostatectomy
2 - Androgen deprivation therapy
3 - Radiotherapy
4 - Brachytherapy
5 - all of the above

A

4 - all of the above
- depends on the patients needs

29
Q

In a patient with organ confined PSA of <20 aged between 70-79 y/o, which of the following would they be be offered or receive?

1 - Active Surveillance
2 - Brachytherapy
3 - Androgen deprivation therapy
4 - Radiotherapy
5 - all of the above

A

5 - all of the above
- they just don’t have a prostatectomy

30
Q

In a patient with organ confined PSA of <20 aged between >80 y/o, which of the following would they be be offered or receive?

1 - Watchful waiting
2 - Androgen deprivation therapy
3 - Radiotherapy
4 - all of the above

A

4 - all of the above

31
Q

In a patient with locally advanced prostate cancer and a PSA 20-100, what is the management for all ages?

1 - Active Surveillance
2 - Androgen deprivation therapy
3 - Radiotherapy
4 - all of the above

A

4 - all of the above

  • this is the same if the patient has metastatic cancer, but instead they just receive chemotherapy in addition
32
Q

According to NICE, what is the level of prostate specific antigen that would require a 2-week referral in a 50-69 y/o male?

1 - >3
2 - >10
3 - >20
4 - >40

A

1 - >3

This value or an abnormal DRE examination

33
Q

Although PSA is used to identify those at risk of prostate cancer it is not the best marker, as other things can cause a rise in PSA. All of the following can cause a rise in PSA, EXCEPT which one?

1 - benign prostatic hyperplasia (BPH)
2 - prostatitis and urinary tract infection
3 - smoking
4 - ejaculation (ideally not in the previous 48 hours)
5 - vigorous exercise (ideally not in the previous 48 hours)
6 - urinary retention
7 - instrumentation of the urinary tract

A

3 - smoking

34
Q

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count?

1 -dexamethasone
2 - granulocyte colony stimulating factors (GCSF)
3 - blood transfusion
4 - frozen WBCs

A

2 - granulocyte colony stimulating factors (GCSF)

A. Block E Oncology (17 decks)

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