Prostate Cancer — MCQs

10 questions

A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesions in his spine. What is the MOST probable diagnosis?

Screening of prostate cancer is commonly done by

Classification system of bone tumors is -

Which GnRH agonist is approved for advanced prostate cancer?

In prostatic metastasis, the site most commonly involved is which one?

Which of the following stages of lip carcinoma does not have nodal involvement?

PSA greater than 20 ng/mL is commonly seen in:

A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Consider the following statements in respect of prostatic carcinoma : 1. Most originate from peripheral zone 2. Prostatic needle biopsy is better performed under trans rectal ultrasound 3. Prostate specific antigen is the specific test 4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

Q10

A patient is diagnosed to have a Stage T3a carcinoma of the prostate. Clinically, this implies

Prostate Cancer Indian Medical PG Practice Questions and MCQs

Question 1: A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesions in his spine. What is the MOST probable diagnosis?

A. Breast Ca.
B. Carcinoma thyroid
C. Pancreatic Ca.
D. Ca. Prostate (Correct Answer)

Explanation: ***Ca. Prostate*** - **Prostate cancer** has a strong predilection for metastasizing to bone and typically produces **osteoblastic lesions** (new bone formation) in the spine [2]. - The presence of **paraplegia** suggests spinal cord compression due to these metastatic lesions [1]. *Breast Ca.* - While **breast cancer** frequently metastasizes to bone (commonly spine, pelvis, ribs, skull), it typically causes **osteolytic lesions** (bone destruction), though mixed lesions can occur. - Paraplegia can result from breast cancer metastases but the primary lesion type is usually osteolytic. *Carcinoma thyroid* - **Thyroid cancer** metastases to bone are rare and generally lead to **osteolytic lesions**, not osteoblastic. - Although it can cause spinal cord compression, the characteristic osteoblastic appearance is not typical for thyroid cancer. *Pancreatic Ca.* - **Pancreatic cancer** rarely metastasizes to bone, and when it does, the lesions are almost exclusively **osteolytic**. - Therefore, it is highly unlikely to be the cause of osteoblastic spinal lesions and subsequent paraplegia.

Question 2: Screening of prostate cancer is commonly done by

A. DRE (digital rectal exam) & PSA (Correct Answer)
B. MRI imaging
C. Surgical intervention
D. Ultrasound-guided procedure

Explanation: ***DRE (digital rectal exam) & PSA*** - **Digital Rectal Exam (DRE)** allows for palpation of the prostate gland to detect **nodules**, **hardness**, or **asymmetry** that may indicate cancer. [1] - **Prostate-Specific Antigen (PSA)** is a blood test that measures a protein produced by the prostate gland; elevated levels can suggest prostate cancer. *MRI imaging* - While **MRI** is used for **staging** and sometimes for **targeted biopsies** of suspicious lesions, it is not a primary screening tool due to its cost and limited availability for broad population screening. - It is typically used *after* abnormal DRE or PSA results, or for monitoring. *Surgical intervention* - **Surgical intervention** (e.g., radical prostatectomy) is a **treatment** for prostate cancer confirmed by biopsy, not a screening method. - Screening aims to *detect* the disease, not to treat it. *Ultrasound-guided procedure* - **Transrectal ultrasound (TRUS)** is primarily used to **guide prostate biopsies** and determine prostate volume, not as a standalone screening test. - It does not have sufficient sensitivity or specificity to be routinely used for initial cancer screening.

Question 3: Classification system of bone tumors is -

A. Enneking (Correct Answer)
B. Edmonton
C. TNM
D. Manchester

Explanation: ***Enneking*** - The **Enneking staging system** is widely used for primary **bone tumors**, particularly sarcomas. - It classifies tumors based on their histological grade, local extension, and presence of metastases, which guides surgical planning and prognosis. *Edmonton* - The **Edmonton classification** is primarily used for **periprosthetic fractures** around hip and knee replacements. - It does not classify primary bone tumors but rather describes fracture patterns related to prosthetic implants. *TNM* - The **TNM (Tumor, Node, Metastasis)** classification is a general staging system used for many types of cancer, but it's not the primary system for bone tumors. - While applicable for some bone cancers, the **Enneking system** provides a more specific functional and anatomical assessment for limb-sparing surgery in bone sarcomas. *Manchester* - The **Manchester staging system** is primarily used for **lymphoma**, particularly Hodgkin lymphoma. - It describes the extent of lymph node involvement and extralymphatic disease, completely unrelated to bone tumors.

Question 4: Which GnRH agonist is approved for advanced prostate cancer?

A. Abarelix
B. Cetrorelix
C. Goserelin (Correct Answer)
D. Ganirelix

Explanation: ***Goserelin*** - **Goserelin** is a **gonadotropin-releasing hormone (GnRH) agonist** approved for the treatment of **advanced prostate cancer**. - It works by initially stimulating, then desensitizing, the pituitary gland to GnRH, leading to a profound decrease in **luteinizing hormone (LH)** and **follicle-stimulating hormone (FSH)**, which in turn reduces **testosterone production**. - This sustained suppression of testosterone is effective in managing hormone-sensitive prostate cancer. *Abarelix* - **Abarelix** is a **GnRH antagonist** (not an agonist), which directly blocks GnRH receptors. - While it was approved for advanced prostate cancer, it works through a different mechanism (antagonism vs agonism) and was later withdrawn from the market. - It is not a GnRH agonist. *Cetrorelix* - **Cetrorelix** is a **GnRH antagonist** (not an agonist) primarily used in **assisted reproductive technology (ART)** to prevent premature ovulation. - It is not approved for the treatment of prostate cancer. *Ganirelix* - **Ganirelix** is a **GnRH antagonist** (not an agonist) also used in **assisted reproductive technology (ART)** to prevent premature LH surges. - It is not approved for the treatment of prostate cancer.

Question 5: In prostatic metastasis, the site most commonly involved is which one?

A. Perivesical nodes
B. Obturator nodes (Correct Answer)
C. Pre-sacral nodes
D. Para-aortic nodes

Explanation: ***Obturator nodes*** - The **obturator nodes** are a primary site for metastatic spread from the prostate due to their close proximity and direct lymphatic drainage pathways. - Prostate cancer cells often spread via the **lymphatic system** to regional lymph nodes before disseminating to distant sites. **Perivesical nodes** * While also regional, perivesical nodes are less frequently the _initial_ or most common site of metastasis compared to the obturator and internal iliac nodes. * Lymphatic drainage from the prostate primarily follows pathways that lead to obturator and internal iliac nodes first. **Pre-sacral nodes** * Pre-sacral nodes are considered more distant regional nodes compared to the obturator nodes and are typically involved later in the metastatic process. * Their involvement often indicates a more advanced stage of nodal metastasis. **Para-aortic nodes** * Para-aortic nodes are considered distant metastases for prostate cancer, indicating widespread disease. * Metastasis to para-aortic nodes usually occurs after involvement of more proximal regional nodes like the obturator and internal iliac nodes.

Question 6: Which of the following stages of lip carcinoma does not have nodal involvement?

A. T2N1
B. T3N0 (Correct Answer)
C. T2N2
D. T1N1

Explanation: ***T3N0*** - The **'N' classification** in the TNM staging system refers to **nodal involvement**. A stage with **'N0' indicates no regional lymph node metastasis**. - A **T3 lesion** signifies a large primary tumor, but if it's accompanied by **N0**, it means there's no evidence of spread to the lymph nodes. *T2N1* - The **'N1' classification** indicates the presence of **regional lymph node metastasis**, specifically in a **single ipsilateral lymph node** that is 3 cm or less in its greatest dimension. - This stage therefore **does have nodal involvement**, contradicting the premise of the question. *T2N2* - The **'N2' classification** signifies more advanced regional lymph node metastasis, such as a **single ipsilateral lymph node** greater than 3 cm but not more than 6 cm. - It could also refer to **multiple ipsilateral lymph nodes**, none greater than 6 cm, or bilateral/contralateral lymph nodes, none greater than 6 cm. In all these cases, **nodal involvement is present**. *T1N1* - Similar to T2N1, the **'N1' component** in T1N1 indicates the presence of **regional lymph node metastasis** in a single ipsilateral lymph node of 3 cm or less. - Therefore, this stage **does involve nodal spread**, despite having a smaller primary tumor (T1).

Question 7: PSA greater than 20 ng/mL is commonly seen in:

A. Prostate cancer (Correct Answer)
B. BPH
C. Prostatitis
D. Bladder cancer

Explanation: ***Prostate cancer*** - A **prostate-specific antigen (PSA)** level greater than **20 ng/mL** is highly suggestive of **prostate cancer**, especially advanced disease, and prompts further evaluation. - While other conditions can elevate PSA, such levels significantly increase the **positive predictive value** for malignancy. *BPH* - **Benign prostatic hyperplasia (BPH)** can elevate PSA, but levels typically remain below **10 ng/mL**, rarely exceeding **20 ng/mL**. - The PSA elevation in BPH is proportional to the **gland size**, which usually doesn't lead to such high values. *Prostatitis* - **Prostatitis** (inflammation of the prostate) can cause a transient, significant increase in PSA, sometimes above **20 ng/mL**. - However, the elevation typically **normalizes** after treatment of the infection or inflammation, unlike in prostate cancer. *Bladder cancer* - **Bladder cancer** does not typically cause an elevation in PSA unless there is concurrent **prostatic involvement** or other prostate pathology. - PSA is a **prostate-specific marker**, so its elevation is not directly indicative of bladder malignancy.

Question 8: A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

A. External beam radiation therapy
B. Androgen deprivation therapy (ADT)
C. Active surveillance
D. Surgical removal of the prostate (Radical prostatectomy) (Correct Answer)

Explanation: ***Surgical removal of the prostate (Radical prostatectomy)*** - **Radical prostatectomy** is the **definitive treatment of choice** for **localized prostate cancer (T2a)** in patients with **good life expectancy (>10 years)**. - For a **65-year-old patient** with tumor confined to the prostate, **surgical removal offers excellent disease control** and potential cure. - This is the **preferred option** when the patient is **medically fit for surgery** and has adequate life expectancy. *External beam radiation therapy* - **External beam radiation therapy (EBRT)** is also an effective treatment for **localized T2a prostate cancer** with comparable long-term survival outcomes. - However, **radical prostatectomy is generally preferred** in younger, healthier patients as it: - Provides definitive pathological staging - Allows for immediate assessment of surgical margins - Preserves radiation as a salvage option if needed - EBRT is better suited for patients who are **not surgical candidates** due to comorbidities or patient preference. *Active surveillance* - **Active surveillance** is appropriate for **very low-risk prostate cancer** (T1c, PSA <10, Gleason ≤6). - For **T2a disease** (palpable tumor), the risk of progression is significant, making active surveillance **not the most appropriate first-line option**. - Would be considered only in patients with limited life expectancy or significant comorbidities. *Androgen deprivation therapy (ADT)* - **ADT** is used for **advanced, locally advanced, or metastatic prostate cancer** to reduce testosterone and slow tumor growth. - It is **not curative** and not appropriate as **monotherapy for localized T2a disease**. - May be used as adjuvant therapy with radiation in higher-risk cases, but not as primary treatment alone.

Question 9: Consider the following statements in respect of prostatic carcinoma : 1. Most originate from peripheral zone 2. Prostatic needle biopsy is better performed under trans rectal ultrasound 3. Prostate specific antigen is the specific test 4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

A. 1 and 3
B. 1 and 2 only
C. 1, 2 and 4 (Correct Answer)
D. 2, 3 and 4

Explanation: ***1, 2 and 4*** - **Most prostatic carcinomas originate from the peripheral zone** (approximately 70%), making this statement correct. This zone is palpable on digital rectal examination. - **Prostatic needle biopsy is indeed better performed under transrectal ultrasound (TRUS) guidance**, which allows for targeted and accurate sampling of suspicious areas. - **LHRH (Luteinizing Hormone-Releasing Hormone) analogues are a cornerstone of medical treatment for metastatic prostate cancer** as they suppress testosterone production, which fuels tumor growth. *1 and 3* - While statement 1 is correct (most prostate cancers originate from the peripheral zone), **prostate-specific antigen (PSA) is not a specific test** for prostate cancer. - **Elevated PSA can be caused by various conditions** such as benign prostatic hyperplasia (BPH), prostatitis, and even normal aging, making it a marker for prostate health rather than a definitive diagnostic test for cancer. *1 and 2 only* - Statements 1 and 2 are correct individually, but this option **incorrectly excludes statement 4**, which is also correct regarding the use of LHRH analogues in metastatic disease. - Therefore, this option is incomplete as it misses a true statement about prostate cancer management. *2, 3 and 4* - This option is incorrect because **statement 3 regarding PSA being a specific test is false**. - While PSA is used for screening and monitoring, its lack of specificity means it cannot definitively diagnose cancer.

Question 10: A patient is diagnosed to have a Stage T3a carcinoma of the prostate. Clinically, this implies

A. Extraprostatic extension through the prostatic capsule (Correct Answer)
B. Involvement of the pelvic wall
C. Involvement of the seminal vesicles
D. Involvement of both the lobes but the disease is limited to within the prostatic capsule

Explanation: ***Extraprostatic extension through the prostatic capsule*** - **T3a prostate cancer** indicates **extraprostatic extension** of the tumor, meaning it has grown beyond the boundaries of the prostate capsule [1]. - This stage specifically denotes microscopic or macroscopic extension through the capsule but without involvement of seminal vesicles or other adjacent structures [1]. *Involvement of the pelvic wall* - **Pelvic wall involvement** signifies a more advanced stage, typically **T4**, where the tumor has invaded adjacent organs or structures beyond the seminal vesicles. - This description goes beyond the definition of a T3a tumor, which is contained within the immediate periprostatic tissue. *Involvement of the seminal vesicles* - **Seminal vesicle invasion** is classified as **T3b** in the TNM staging system for prostate cancer, differentiating it from T3a [1]. - T3a specifically excludes seminal vesicle involvement, focusing solely on extraprostatic extension [1]. *Involvement of both the lobes but the disease is limited to within the prostatic capsule* - **Involvement of both lobes** while remaining within the prostatic capsule is characteristic of a **T2c** stage prostate cancer. - T3a implies extension *beyond* the capsule, which contradicts the statement that the disease is limited to within it.

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