Data Quality - Prostate

What statement(s) is true regarding the assessment of nodal metastasis for prostate cancer?

• An MRI is an effective alternative for evaluating nodal disease.

• A pelvic lymph node dissection (PLND) is the most accurate method to assess metastasis to the pelvic lymph nodes.

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

An MRI is a poor tool for evaluating nodal disease. A pelvic lymph node dissection (PLND) remains the most accurate method to assess metastasis to the pelvic nodes. Both an open and a laparoscopic PLND have been shown to accurately assess pelvic nodes equally effectively.

What procedure(s) is usually included as part of active surveillance for clinically localized prostate cancer patients?

• Transrectal ultrasound

• Prostate-specific antigen (PSA) testing

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

The strategy behind active surveillance is to defer therapy but regularly follow the patient to be able to initiate local therapy with curative intent if there are signs of local tumor progression. For clinically localized cases of prostate cancer, the idea is to avoid the morbidity of therapy in men who have nonprogressive disease while preserving the ability for a cure if the tumor progresses. Active surveillance or watchful waiting usually involves:

Regular patient visits

Digital rectal examinations

Prostate-specific antigen (PSA) testing

Transrectal ultrasound

Transrectal needle biopsies

Under what circumstance(s) is radiation considered postoperatively?

• When seminal vesicle invasion is found pathologically following the prostatectomy

• When there is a detectable PSA level more than 3 weeks postoperatively

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

Postoperative radiation therapy (PORT) is considered for patients who are found to have seminal vesicle invasion by tumor at the time of prostatectomy or who have a detectable PSA level more than 3 weeks postoperatively.

What term(s) refers to a way of dividing a total dose of radiation into separate doses that are smaller than usual?

• Fractionation

• Hypofractionation

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

Fractionation is the broad term used to describe a way of dividing a total dose of radiation or chemotherapy into separate doses that are larger or smaller than usual.

In hyperfractionated radiation therapy, the total dose of radiation is divided into small doses and treatments are given more than once a day. Hyperfractionated radiation therapy, also known as superfractionated radiation therapy, is given over the same period of time (days or weeks) as standard radiation therapy.

In hypofractionated radiation therapy, the total dose of radiation is divided into large doses and treatments are given once a day or less often.

What is an example(s) of androgen deprivation therapy (ADT) used to reduce the levels of testosterone and dihydrotestosterone (DHT) in the body?

• Surgery

• Drugs

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

ADT reduces the levels of androgen hormones, with surgery (e.g., bilateral orchiectomy) or drugs (antiandrogens) to prevent the prostate cancer cells from growing.

What is used to predict one person's risk, the treatment plan to recommend, and the outcome of their prostate cancer?

• Risk groups

• Nomograms

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

Risk groups are used to describe people who are alike in important ways. Patients with the same type of cancer may be divided into different risk groups that depend on certain aspects of their disease or that share traits and behaviors that affect their chance of developing a particular cancer. Treatment may be based on which risk group a patient falls into.

Nomograms predict one person's risk better than risk groups. A nomogram is a mathematical model that shows relationships between things. For example, a nomogram of height and weight measurements can be used to find the surface area of a person, without doing the math, to determine the right dose of chemotherapy. Nomograms of patient and disease characteristics can help predict the outcome of some kinds of cancer.

How many small incisions are typically made during a robotic-assisted laparoscopic radical prostatectomy procedure?

• 1

• 2

• 3

• None of the above

Answer explanation

During a typical robotic-assisted laparoscopic radical prostatectomy procedure, a surgeon, assistant, and voice-controlled robotic arm work through 5 entry sites for the introduction of surgical instruments. A laparoscope is introduced in the subumbilical site and is used to guide the operation. The surgeon and assistant each use the other four sites for the introduction of instruments.

What key words are thought to represent possible involvement with cancer on a bone scan or CT scan of the bone?

• Area(s) of increased uptake

• Area of increased attenuation

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

The key words that represent possible involvement on a prostate ultrasound include:

Abnormal density

Abnormal echo

Area of increased attenuation

The keywords that represent possible involvement on a bone scan, CT scan of the bone, or a metastatic skeletal survey include:

Area(s) of increased uptake

Blastic lesion

Lytic lesion

Osteoblastic lesion

Osteolytic lesion

What statement(s) is true regarding the enzyme alkaline phosphatase (ALP)?

• ALP is made mostly in the bone.

• High levels of ALP might indicate prostate cancer metastasis to the bone

• Both (a) and (b)

• Neither (a) nor (b)

Answer explanation

An alkaline phosphatase (ALP) test measures the amount of the ALP enzyme in the blood. It is made mostly in the liver but it also is made in the bone, intestines, and kidneys. Some conditions, such as metastatic bone disease, cause large amounts of ALP in the blood; therefore, this is one test that can be done to check on whether bone metastasis is present.

Which portion of the prostate is directed downward and is in contact with the superior fascia of the urogenital diaphragm?

• Apex of the prostate

• Base of the prostate

• Central zone of the prostate

• None of the above

Answer explanation

The apex of the prostate is directed downward and is in contact with the superior fascia of the urogenital diaphragm.

The base of the prostate is directed upward near the interior surface of the bladder with the greater part of this surface being directly continuous with the bladder wall.

The prostate can also be divided into three glandular zones according to their function. Prostate cancer can begin and spread from any of these zones. They are referred to as the following:

Central zone surrounds the ejaculatory ducts and accounts for approximately 2.5% of prostate cancers. Cancers arising in this zone tend to be more aggressive and more likely to invade the seminal vesicles.

Peripheral zone is the sub-capsular portion of the posterior aspect of the prostate gland that surrounds the distal urethra. Approximately 70-80% of prostate cancers originate here.

Transitional zone surrounds the proximal urethra and is the region of the prostate gland that grows throughout life and is responsible for benign enlargement of the prostate. Approximately 10-20% of prostate cancers originate in this zone.