Prostate cancer is the most common noncutaneous cancer in men. Although prostate cancer can be slow-growing, thousands of men die of the disease each year. It is the second most common cause of cancer death in males. Do you know what to watch for and best practices? Test yourself with our short quiz.
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Which of the following presentations of prostate cancer is most common?
Squamous cell carcinoma found in the peripheral zone
Acinar adenocarcinoma found in the central zone
Acinar adenocarcinoma found in the peripheral zone
Sarcoma found in the transitional zone
Most prostate cancers (95%) are adenocarcinomas. Approximately 4% of cases of prostate cancer have transitional cell morphology and are thought to arise from the urothelial lining of the prostatic urethra. The few cases that have neuroendocrine morphology are believed to arise from the neuroendocrine stem cells normally present in the prostate or from aberrant differentiation programs during cell transformation.
Squamous cell carcinomas constitute less than 1% of all prostate carcinomas. In many cases, prostate carcinomas with squamous differentiation arise after radiation or hormone treatment. Of prostate cancer cases, 70% arise in the peripheral zone, 15%-20% arise in the central zone, and 10%-15% arise in the transitional zone. Most prostate cancers are multifocal, with synchronous involvement of multiple zones of the prostate, which may be due to clonal and nonclonal tumors.
For more on the pathophysiology of prostate cancer, read here.
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"Infiltration of cells from glands at margins" indicates which Gleason grade?
1
2
3
5
The standard approach for grading prostate cancer depends on a Gleason score, which is based on pathologic evaluation of a prostatectomy specimen and is commonly estimated from prostate biopsy tissue. Prostate cancer patterns are assigned a grade from 1 to 5; the score is created by adding the most common pattern and the highest-grade patterns. Grade 3 is indicated by distinctly infiltrative margins.
For more on the staging of prostate cancer, read here.
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Which of the following is recommended according to guidelines from the National Comprehensive Cancer Network (NCCN)?
Routine prostate-specific antigen (PSA) testing in men older than 75 years
Repeat PSA testing every 1-2 years in men aged 50-70 years with normal digital rectal examination (DRE) findings and PSA level below 3 ng/mL
Annual retesting in patients with a PSA level 0.5-0.7
Prostate biopsy at a PSA level of 2 ng/mL
The NCCN issued revised guidelines on prostate cancer screening in 2014; the guidelines are based on recommendations by the majority of panel members rather than consensus. The NCCN recommends performing a baseline history (including family history, medications, and any history of prostate screening and disease) and physical examination. The clinician should then discuss the risks and benefits of a baseline PSA test with the patient, and consider a baseline DRE to identify high-risk cancers associated with a seemingly normal PSA.
In patients with a normal DRE result, the NCCN recommends baseline PSA testing at age 45-49 years, with retesting at age 50 years in patients with a level below 0.7 ng/mL (the age-specific median) and annual or biannual retesting in those with a level of 1.0 ng/mL or higher. For patients aged 50-70 years with a normal DRE and a PSA below 3 ng/mL, the NCCN recommends retesting every 1-2 years.
NCCN panel members were divided on the question of PSA thresholds that would prompt prostate biopsy: 2.5 ng/mL has been used, whereas 3 ng/mL is evidence-based and reduces the risk for overdetection; however, some panel members recommended considering the PSA level in the context of other risk factors rather than using a specific PSA cutoff. In selected cases, risk calculators could be used to stratify risk.
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Which of the following combinations of imaging studies provide good imaging of the prostate and increase the yield of positive biopsies by targeting abnormal areas?
MRI and CT
Ultrasonography and CT
MRI and ultrasonography
PET and ultrasonography
MRI fusion biopsies under ultrasonographic guidance have produced higher yields of prostate cancer by targeting the abnormal areas on MRI and overlaying them onto the ultrasonographic images during transrectal prostate biopsy.
For more on the workup of prostate cancer, read here.
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Which of the following is not typically recommended as a treatment option for locally confined, medium-risk prostate cancer in a 69-year-old healthy man?
External-beam radiation therapy
Robotic prostatectomy
Total androgen deprivation
Watchful waiting
Hormone therapy for prostate cancer is also known as "androgen deprivation therapy." It may consist of surgical castration (orchiectomy) or medical castration. Agents used for medical castration include luteinizing hormone-releasing hormone analogues or antagonists, antiandrogens, and other androgen suppressants. This treatment is reserved for advanced disease or prostate cancer that is poorly differentiated in a patient who is unable to receive other treatment.
For more the treatment of prostate cancer, read here.
