Tumors of the prostate 1000+ MCQ with answer for XAT

1. What is false concerning TRUS prostatic biopsy?
A. a 12-core biopsy is the standard
B. in preparation for the procedure, a self-administered enema is suggested
C. sepsis might complicate the procedure
D. the biopsy path is best visualized in the coronal plane
Answer : D

2. For prostate cancer patients, what do Partin tables predict?
A. survival rate
B. pathologic stage
C. extracapsular extension
D. lymph node involvement
Answer : B

3. What is the likelihood that patients with positive surgical margins after radical prostatectomy will be cured for prostate cancer?
A. never
B. unlikely
C. likely
D. always
Answer : C

4. Ectopic expression of PSA occurs in all of the following, EXCEPT:
A. thyroid gland
B. breast tissue
C. adrenal glands
D. renal carcinomas
Answer : A

5. What fraction of men with a PSA value between 4 and 10 ng/mL has an organ-confined prostate cancer?
A. ?
B. ¼
C. ½
D. ?
Answer : D

6. What is against using TRUS-guided therapy for focal prostate cancer?
A. it overdiagnoses clinically insignificant cancers
B. it misses clinically significant cancers in the anterior or apical regions
C. it may underrepresent true cancer burden
D. all of the above
Answer : D

7. All of the following modalities are used as salvage therapies after failing radiation therapy for prostate cancer treatment, EXCEPT:
A. cryotherapy
B. chemotherapy
C. brachytherapy
D. radical prostatectomy
Answer : B

8. In which of the following situations prostate biopsy is most indicated?
A. normal DRE, abnormal PSA
B. abnormal DRE, abnormal PSA
C. abnormal DRE, normal PSA
D. hyperechoic areas on TRUS
Answer : B

9. What is the first-line chemotherapeutic agent for metastatic castration-resistant prostate cancer?
A. bisphosphonate
B. docetaxel
C. sipuleucel-T
D. enzalutamide
Answer : B

10. What is false regarding the diagnosis of prostate cancer?
A. most cases are identified by screening asymptomatic men
B. physical examination alone cannot reliably differentiate benign prostatic conditions from cancer
C. most diagnosed cases have normal DRE and PSA values
D. prostate biopsy establishes the diagnosis
Answer : C

11. Genetically, what are the changes associated with poor survival in prostate cancer patients?
A. loss of one or both copies of the tumor suppressor gene PTEN
B. TMPRSS2ERG chromosome fusion
C. P53 mutations and overexpression of MYC
D. all of the above
Answer : D

12. In descending order, to where do prostate cancers metastasize?
A. lymph nodes, bone, lung, bladder, liver, and adrenal glands
B. bone, lung, lymph nodes, liver, bladder, and adrenal glands
C. lung, liver, lymph nodes, bone, adrenal glands, and bladder
D. liver, lung, bone, lymph nodes, bladder, and adrenal glands
Answer : A

13. Regarding treating prostate cancer patients, watchful waiting is a reasonable option for:
A. patients who have a life expectancy ? 10 yrs. and/or well to moderately differentiated cancer
B. ? 70 yrs. of age
C. PSA < 10 ng/mL, ratio < 0.22
D. patients with good performance status
Answer : A

14. What is false concerning thawing procedure to treat prostate cancer cells?
A. slow thawing is more effective than rapid thawing
B. the most common complication is erectile dysfunction
C. for effective thawing a minimum temperature of ? 25° C and a double freeze/thaw cycle with urethral warming are recommended
D. the two most common modalities employed in focal therapy are highintensity focused ultrasound and cryosurgery
Answer : C

15. What pathologic findings after radical prostatectomy are predictive for occult metastases?
A. seminal vesicle invasion and lymph node metastases
B. positive surgical margins and seminal vesicle involvement
C. capsular penetration and lymph node metastases
D. rectal and bladder neck involvement
Answer : A

16. Regarding radiotherapy for prostate cancer, what is the lowest recommended dose for salvage therapy?
A. 54 Gy
B. 64 Gy
C. 74 Gy
D. 84 Gy
Answer : B

17. During retropubic radical prostatectomy, what complication could be encountered on dividing the dorsal vein complex anteriorly?
A. incontinence
B. retrograde ejaculation
C. impotence
D. anejaculation
Answer : A

18. Partin tables are probability tables for the determination of pathologic stages of prostatic cancers based on:
A. preoperative clinical stage, PSA level, and Gleason sum
B. seminal vesicle invasion, lymph node metastases, and Gleason sum
C. positive surgical margins, capsular penetration, and PSA level
D. PSA level, perineural invasion, vascular metastasis, and Gleason sum
Answer : A

19. Regarding chemotherapy for prostate cancers, nonsteroidal antiandrogens will result in:
A. elevated LH, elevated testosteone, elevated estrogen
B. elevated LH, elevated testosterone, declined estrogen
C. declined LH, declined testosterone, elevated estrogen
D. declined LH, elevated testosterone, declined estrogen
Answer : A

20. What is true about the usefulness of Gleason scoring system?
A. used to stage prostate cancer
B. a specimen of grade 3 + 4 is worse than 4 + 3
C. a sum of 6 suggests an intermediate risk for aggressive cancer
D. it has a role in guiding the appropriate treatment options
Answer : D

21. Regarding radical prostatectomy, the commonest site of positive surgical margins is the:
A. apex
B. posterior
C. postero-lateral
D. anterior
Answer : A

22. What is false regarding the histology of prostatic cancers?
A. benign glands are different from malignant glands, as they contain basal cells
B. adenosis in the transitional zone carries 15% increase in cancer risk
C. the prostate has no discrete histologic capsule
D. intraductal carcinoma is morphologically worse than high-grade PIN and is typically associated with high-grade carcinoma
Answer : B

23. What advantage does laparoscopic/robotic prostatectomy has over open surgery in treating prostate cancers?
A. preserving potency
B. avoiding incontinence
C. less bleeding
D. all of the above
Answer : C

24. What is true regarding seminal vesicles` involvement in prostate cancer?
A. is almost always due to direct extension (T2c)
B. it is involved in 85% of positive surgical margins following radical prostatectomy
C. it carries a poor prognosis
D. none of the above
Answer : C

25. What is the major advantage of neoadjuvant androgen deprivation before radical prostatectomy on treating clinical stages (cT1-T2) prostate cancers?
A. reduces positive surgical margins
B. reduces local recurrence
C. has no proven advantage
D. reduces cardiac complications
Answer : A

26. In which of the following cases PSA testing is NOT indicated:
A. 72 yrs. man newly diagnosed BPH with normal DRE
B. 2 weeks post TURP for obstructing cancerous prostate
C. screening for prostate cancer in 75 yrs. old Caucasian man
D. 43 yrs. man with obstructive LUTS, who had a first-degree relative diagnosed with prostate cancer before age 65
Answer : C

27. Which factor is closely related to the return to urinary continence function after radical retropubic prostatectomy?
A. pathologic tumor stage
B. performing nerve-sparing surgery
C. patient`s age
D. performing internal sphincter micro-dissection
Answer : C

28. In descending order, the commonest complications of external beam radiation therapy for prostate cancer are:
A. urethral stricture, impotence, and rectal bleeding
B. impotence, rectal bleeding, and urethral stricture
C. impotence, urethral stricture, and rectal bleeding
D. rectal bleeding, impotence, and urethral stricture
Answer : B

29. What is false concerning Gleason scoring system for prostate cancers?
A. ranges from 0 -10 based on a histologic evaluation of tumor specimens
B. based on the 2 most common histologic patterns
C. greatly relies on the skills and experience of the pathologist
D. a score of 7 indicates a moderate-grade or moderately differentiated tumor
Answer : A

30. What is the likelihood that prostate cells die in a single freeze cycle of cryotherapy when tissue temperature reaches colder than - 400 C?
A. never
B. unlikely
C. likely
D. always
Answer : D

31. What is the commonest complication of high-intensity focused ultrasound on treating localized prostate cancer?
A. temporary incontinence
B. vasculogenic impotence
C. urinary retention
D. hyper-reflexive detrusor
Answer : C

32. Concerning prostate cancers, a pre-treatment PSA velocity of > 2 ng/mL/yr is associated with an increased risk of:
A. pathological bone fractures
B. biochemical failure following radiation therapy
C. hepato-renal disease following chemotherapy
D. upgrading the pre-treatment risk stratification
Answer : B

33. Which factor(s) determine(s) the return to normal erectile function after radical retropubic prostatectomy?
A. the age of the patient
B. preoperative potency status
C. extent of nerve-sparing surgery
D. all of the above
Answer : D

34. Fill the blanks: on treating prostate cancer patients, the median time from PSA failure to the development of metastatic disease after radical prostatectomy is approximately (…) yrs. and from the time of metastases to death is approximately (…) yrs..
A. 4, 2 respectively
B. 8, 5 respectively
C. 6, 3 respectively
D. 7, 4 respectively
Answer : B

35. What is true surrounding PSA?
A. black individuals produce more PSA than whites
B. ejaculation can lead to a false decrease in PSA
C. pro-PSA is the serum proactive form of PSA molecule
D. prostate cancer cells make more PSA than normal prostate tissues do
Answer : A

36. What is false regarding prostate adenocarcinoma in the peripheral zone?
A. 85% of prostate adenocarcinomas are located in the peripheral zone
B. 15% of them are multifocal
C. they tend to extend outside the prostate through the perineural space
D. the presence of perineural invasion does not worsen the prognosis
Aswer : B

37. What condition does NOT appear as a hypoechoic lesion in the prostate on TRUS?
A. prostate cancer
B. corpora amylacea
C. transitional zone
D. tuberculous prostatitis
Answer : B

38. What is true regarding prostatic tissue levels of hK2?
A. intensely expressed in benign prostatic epithelium
B. increased in poorly differentiated prostate cancer tissue
C. helps differentiate benign from malignant causes of high t-PSA
D. is an organ but not pathology specific marker
Answer : B

39. Following bilateral orchiectomy for prostate cancer, testosterone will:
A. initially drop to nadir, and then recover over 2 weeks
B. decline by 50% within 2 weeks and then normalize
C. decline by 90% within 24 hours
D. decline by 70%
Answer : C

40. What is false concerning antiandrogen class of prostate cancer medications?
A. commonly used in combination with a GnRH agonist
B. less effective than medical or surgical castration
C. not recommended for localized prostate cancer
D. inhibits various cytochrome P-450 enzymes
Answer : D

41. What is the proper pre-treatment risk stratification of prostate cancer for a patient with T2a, PSA < 11 ng/mL, and no Gleason score > 6?
A. low risk
B. intermediate risk
C. high risk
D. data not adequate
Answer : A

42. What is the primary mechanism of prostate tissue ablation using high-intensity focused ultrasound?
A. disruption of protein synthesis
B. coagulative necrosis
C. cell wall destruction
D. DNA damage
Answer : B

43. What is false concerning the interpretation of Gleason scoring system?
A. a low score means the cancer tissue is similar to normal prostate tissue
B. it indicates how likely the tumor will spread
C. the more cellular atypia observed the higher scoring will be
D. it relies only on the glandular architectural pattern
Answer : C

44. Prostate-specific membrane antigen has been detected in:
A. the prostate gland only
B. the central nervous system, intestine, and the prostate
C. malignant ovarian cysts, skeletal muscles, and the prostate
D. thyroid glands, adrenals, and the prostate
Answer : B

45. Screening for prostate cancer is recommended for men who are:
A. at average risk, aging 50 yrs., and have at least a 10-year life expectancy
B. aging 40 yrs., and had a first-degree relative diagnosed with prostate cancer before age 65
C. aging 40 yrs., African Americans
D. all of the above
Answer : D

46. Clinically significant prostate cancer is defined as:
A. volume ? 0.5 mL and/or a Gleason score of ? 3 + 4
B. volume ? 0.8 mL and/or a Gleason score of ? 4 + 4
C. volume ? 1.5 mL and/or a Gleason score of ? 4 + 3
D. volume ? 1.0 mL and/or a Gleason score of ? 3 + 3
Answer : A

47. Solid lesions in the seminal vesicles are most likely to be a result of:
A. imperfect prostate biopsies
B. immature teratoma
C. schistosomiasis
D. liposarcoma
Answer : C

48. What is false concerning prostate cancer?
A. the most common cause of mortality in men with prostate cancer is cardiac disease
B. is the second most common cause of cancer death in males
C. androgens have a pivotal role in prostate cancer development
D. low protein and high carbohydrate diet play a role in the development of prostate cancer
Answer : D

49. Regarding treating prostate cancer patients, watchful waiting strategy involves:
A. periodic PSA testing
B. periodic TRUS
C. all of the above
D. none of the above
Answer : D

50. Which PSA value interpretation is incorrect?
A. > 50% of men with PSA > 10 ng/mL have the disease beyond the prostate
B. pelvic lymph node involvement is found in PSA > 20 ng/mL
C. 70% of men with a PSA between 4 and 10 ng/mL have organ-confined disease
D. 80% of men with PSA < 4 ng/mL have organ-confined disease
Answer : B