Multiple Choice Questions MCQ

Question 4# Print Question

Which finding is TRUE in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), comparing radical prostatectomy versus watchful waiting in the management of early prostate cancer after up to 10 years follow-up?

A. Radical prostatectomy reduces prostate cancer-specific mortality, overall mortality, the risks of metastasis and local progression compared with watchful waiting

B. Radical prostatectomy has no benefit in terms of overall survival

C. Radical prostatectomy has no benefit in terms of disease specific survival

D. Radical prostatectomy has no benefit in terms of reducing prostate cancerspecific mortality, overall mortality, the risks of metastasis or local progression

E. With longer follow up any difference in terms of cancer specific survival between the radical prostatectomy and watchful waiting is likely to decrease

Question 1# Which of the following is TRUE regarding adenocarcinoma of the prostate?
A. Is the fourth commonest cause of male cancer death in the UK
B. Is more common in men than breast carcinoma is in women
C. Is more common in the transition zone than in the peripheral zone
D. Has never been recorded in patients with congenital 5α-reductase deficiency
E. The critical feature in the pathological diagnosis is preservation of basal cell layer
Answer D Prostate cancer is the second leading cause of male cancer death in the UK. The incidence of breast cancer exceeds that of prostate cancer in the UK (55,200 vs. 47,740, respectively). In total, about 75% of adenocarcinoma arise from the peripheral zone with the rest arising from the transition zone. Neither benign prostate hyperplasia (BPH) nor prostate cancer has ever been reported in patients with 5α-reductase deficiency. Absence of the basal layer distinguishes malignant from benign prostate acini.

Question 2# Which of the following is NOT a recognised side effect of LHRH agonists in the treatment of carcinoma of the prostate?
A. Osteoporosis
B. An initial drop in plasma testosterone
C. Gynaecomastia
D. Hot flushes
E. Erectile dysfunction
Answer B The plasma testosterone initially rises (the tumour flare), so an anti-androgen, such as bicalutamide, is given for 3 days before and 3 weeks after starting an LHRH agonist. The remainder all are recorded side effects for androgen deprivation therapy, anti-androgens have similar side effects but with better preservation of potency and libido.

Question 3# Which of the following is TRUE regarding brachytherapy monotherapy for prostate cancer?
A. Should be considered in the management of intermediate- and high-risk localised prostate cancer
B. HDR uses palladium¹⁰³ as the radioactive source
C. Low dose rate (permanent seed implantation) (LDR) and high dose rate (HDR) temporary implantation represent the two types of brachytherapy
D. There is no limitation in relation to prostate size
E. A ‘PSA bounce’ is less common after brachytherapy than after external beam radiotherapy
Answer C According to NICE guidelines brachytherapy is considered an option in low- and intermediaterisk groups. Iridium192 is the radioisotope used in high dose brachytherapy in combination with external beam radiotherapy. Iodine125 and palladium103 are used in low dose brachytherapy. Prostate volume of 50–60 mL is considered the upper limit for BXT treatment due to pubic arch interference preventing insertion of the source in some of the anterior gland. Further Reading: Georgios Koukourakis et al. Brachytherapy for Prostate Cancer: A Systematic Review, Advances in Urology, Volume 2009, Article ID 327945, 11 pages.

Question 5# Which of the following drugs have shown efficacy in the treatment of ‘hot flushes’ following hormonal treatment for advanced prostate cancer?
A. Diethylstilbestrol
B. 5α-reductase inhibitors
C. Medroxyprogesterone acetate
D. Tamsulosin
E. Clonidine
Answer C Medroxyprogesterone 20 mg od has been shown to significantly reduce hot flushes; cyproterone acetate also reduces flushes. Further Reading: Irani J et al. Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: A double-blind, randomised trial. Lancet Oncol 2010; 11(2): 147–154.

Question 4# Which finding is TRUE in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), comparing radical prostatectomy versus watchful waiting in the management of early prostate cancer after up to 10 years follow-up?
A. Radical prostatectomy reduces prostate cancer-specific mortality, overall mortality, the risks of metastasis and local progression compared with watchful waiting
B. Radical prostatectomy has no benefit in terms of overall survival
C. Radical prostatectomy has no benefit in terms of disease specific survival
D. Radical prostatectomy has no benefit in terms of reducing prostate cancerspecific mortality, overall mortality, the risks of metastasis or local progression
E. With longer follow up any difference in terms of cancer specific survival between the radical prostatectomy and watchful waiting is likely to decrease
Answer A Radical prostatectomy reduces disease-specific mortality, overall mortality and the risks of metastasis and local progression compared with watchful waiting after up to 10 years follow-up. Further Reading: Bill-Axelson A, Radical prostatectomy or watchful waiting in prostate cancer—29-Year follow-up. N Eng J Med 2018; 379: 2319–2329.

Your-Doctor Multiple Choice Questions (MCQ)

Your-Doctor
Multiple Choice Questions (MCQ)