Westra: Prevention and Treatment of Carcinoma

Question 1

MC cancer in men

Answer 1

prostate cancer

Question 2

MC age group at dx for prostate caancer

Answer 2

65-74

Question 3

ethnic group w/ highest incidence and death rate

Answer 3

AA

Question 4

only RFs incorporated into current screening recommendations

Answer 4

African American

family hx

Question 5

male relatives of bresat cancer pts BRCA 1/2

man w/ 1st degree relative w/ prostate cancer 2x

Answer 5

increases risk of prostate cancer

Question 6

folic acid, dairy and Ca relation to PC

Answer 6

increases risk possibly

Question 7

high plasma testosterone levels

Answer 7

increase risk of PC

Question 8

dioxin

Answer 8

exposed on the ground in Vietnam

increases risk of PC

Question 9

may decrease risk of prostate cancer

Answer 9

lycopene

folate

Question 10

finasteride and dutasteride

Answer 10

decrease INCIDENCE of prostate cancer

decrease size w/ BPH

Question 11

pt w/ PC will most likley have what sxs

Answer 11

Asymptomatic or sx of lower UT obstruction

Question 12

hip/back pain
difficulty/frequent urination
hematuria

Answer 12

PC

Question 13

Detection fo PC

Answer 13

PSA
digital rectal exam
transrectal US
biopsy

Question 14

normal PSA

Answer 14

<4

*usually total

Question 15

PSA 4-10

Answer 15

borderline

Question 16

PSA >10

Answer 16

high

*higher hte PSA the more likley the presence of PC

Question 17

PSA velocity

Answer 17

measures how quickly PSA rises over period of time

change of >75 rise in one year is SIGNIFICANT

Question 18

most prostate cancer begs in posterior part of gland in what zone?

Answer 18

peripheral zone

Question 19

if digital rectal exam is abnormal?

Answer 19

trans-rectal US

Question 20

important tool to assess size of prostate and identify areas that need to be biopsied

Answer 20

transrectal US

Question 21

what is the screening controversy around PSA

Answer 21

unclear whether the PSA blood test saves lives or whether it exposes men to unnecessary physical and emotional anguish

Question 22

USPSTF recommends

Answer 22

AGAINST PSA screening in healhty asymptomatic men regardless of RF

Question 23

when can you start screening African american males?

Answer 23

age 40-45

Question 24

ACS recomends taht you should screen

Answer 24

age 50 for average risk and lifetime survival of 10 years

40-45 for high risk men

Question 25

when to take a biopsy

Answer 25

abnormality palpated by DRE elevated PSA on age adjusted reference range PSA velocity >.75 previous neagative biopsy but increasing PSA

Question 26

what are most prostate cancers?

Answer 26

adenocarcinomas

Question 27

``` 55 y/o M nocturia normal DRE PSA 6 subsequent biopsy+ for adenocarcinoma ```

Answer 27

radical prostatectomy He's 55! radiation woried about rectal problems and diarrhea a little young for orchiectomy

Question 28

``` 78 y/o M increased freq/hesitancy nodular DRE PSA 15 Pos biopsy ```

Answer 28

RADIATION Therapy he's doing to well for active surveillance Don't want bone mets

Question 29

``` 74 y/o M severe O2 dep COPD hesitancy enlarged prostate on DRE PSA 8 declined biopsy ```

Answer 29

active surveillance if he is really worried you can talk about radiation wound need to do biopsy first

Question 30

94 y/o firm nodular prostate urinary retention PSA 100

Answer 30

bilateral orchiectomy and transurethral resection decreased testosterone and let him go to the bathroom

Question 31

less aggressive tumors >70 w/ co existent illnesses potential tx SE palliative therapy

Answer 31

active surveillance

Question 32

radical prostatectomy

Answer 32

removal of prostate and seminal vesicles 50-65 w/out comorbidities only occurs if cancer has not spread outside prostate gland

Question 33

SE of radical prostatectomy

Answer 33

impotence | urinary incontinence

Question 34

transurethral resection

Answer 34

removes cancerous section of PG

Question 35

destroys prostate cancer by freezing the prostate tissue w/ cryoprobes

Answer 35

cryosurgery

Question 36

complications of cryosurgery

Answer 36

bladder outlet injury urinary incontinence impotence

Question 37

radiation therapy for pts not candidate for radical prostaectomy

Answer 37

Extrernal beam radation for T3 and T4 >70 damage rectum, impotency, urinary incontinence

Question 38

tx for locally advanced prostate cancer

Answer 38

hormonal therapy LHRH agonists> decrease amt of testosterone in hte body

Question 39

tx for progressive disease or recurrent after tx, metastatic disease

Answer 39

docetaxel + prednisone | Cabazitaxel

Question 40

best way to monitor for recurrent cancer

Answer 40

PSA