Which of the following is TRUE regarding adenocarcinoma of the prostate?
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.
Which of the following is NOT a recognised side effect of LHRH agonists in the treatment of carcinoma of the prostate?
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.
Which of the following is TRUE regarding brachytherapy monotherapy for prostate cancer?
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.
Georgios Koukourakis et al. Brachytherapy for Prostate Cancer: A Systematic Review, Advances in Urology, Volume 2009, Article ID 327945, 11 pages.
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?
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.
Bill-Axelson A, Radical prostatectomy or watchful waiting in prostate cancer—29-Year follow-up. N Eng J Med 2018; 379: 2319–2329.
Which of the following drugs have shown efficacy in the treatment of ‘hot flushes’ following hormonal treatment for advanced prostate cancer?
Medroxyprogesterone 20 mg od has been shown to significantly reduce hot flushes; cyproterone acetate also reduces flushes.
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.
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