In the report of the American Joint Committee on Cancer (2018), which of the following is CORRECT?
T1 disease is not palpable or visible with imaging, non-regional (extrapelvic) lymph node involvement is classified M1a. Tumour involving but not penetrating through the capsule is pT2 (p denotes ‘pathological’). Tumour found in both lobes by needle biopsy, but not palpable or visible by imaging, is classified as T1c.
Which of the following is TRUE regarding the pathogenesis of prostate cancer?
It is estimated 9% of prostate cancer is hereditary, other risk factors include ethnicity and increasing age, the incidence of latent/indolent prostate cancer is very similar throughout the world.
In the Prostate Cancer Prevention Trial, how many men over 62 years old with a normal PSA (≤4 ng/mL) and a normal rectal examination had prostate cancer on TRUS biopsy and how many men with cancer had Gleason ≥7 disease?
The ‘Prostate Cancer Prevention Trial’ (PCPT) randomised 18,882 men to either finasteride or placebo. Eligibility criteria were prostate specific antigen (PSA) <3 ng/mL, age ≥55 years and a normal digital rectal examination (DRE). Participants underwent yearly PSA and DRE checks. A 6-core biopsy was performed if the PSA rose to 4 ng/mL. Overall a 25% relative risk and 4% absolute reduction in prostate cancer was seen, primarily tumours ≤Gleason 6. However, an absolute 15% increase in Gleason 7 and above tumours was seen in the treatment arm.
Which of the following is CORRECT regarding men with localised prostate cancer treated with radiotherapy?
The RTOG 9292 study reported significant improvement in local control, the development of metastases and disease-free survival in patients receiving long-term ADT and overall survival in men with GS 8–10 disease. Numerous studies demonstrate the benefit of dose escalation, there is no good evidence that pelvic irradiation is of benefit in N0 disease. Radiotherapy does increase the risk of bladder cancer by 2.3x and rectal cancer by 1.7x. The Phoenix Consensus Conference definition of PSA failure (with an accuracy of >80% for clinical failure) is any PSA increase >2 ng/mL higher than the PSA nadir value, regardless of the serum concentration of the nadir.
Which of the following information on molecular markers in prostate cancer is CORRECT?
PCA3 is overexpressed in prostate cancer, kallikrein 3 is also known as PSA so rises in metastatic disease, high molecular weight cytokeratin binds basal cells – malignant acini lack basal cells. PSA doubling time and PSA velocity provide limited predictive information over PSA alone in prostate cancer diagnosis.
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