Devita, Hellman, and Rosenberg's Cancer

LWBK1006-21 LWW-Govindan-Review December 12, 2011 19:6

Chapter 21•Genitourinary Cancer 283

Question 21.16. Which of the following statements about the molecular pathogenesis of

urothelial cancer of the bladder is INCORRECT?

A. Chromosome 9 deletions are common and occur on both the short

and long arms.

B. p53 mutations are associated with carcinoma in situ and aggressive

disease.

C. pRb alterations are observed and correlate with poor prognosis.

D. Activating FGFR3 mutations are most common in metastatic lesions.

Question 21.17. A 71-year-old man without significant medical history presents with

hematuria and flank pain. CT scan reveals a mass at the pelvic-

ureteral junction with associated hydronephrosis, but no associated lym-

phadenopathy. Cystoscopy and ureteroscopy reveal an obstructing mass

at the pelvic-ureteral junction, and cytology is diagnostic for a urothelial

cancer. Which of the following is the MOST appropriate therapy?

A. Open nephroureterectomy and bladder cuff resection

B. Open radical nephrectomy with retroperitoneal lymph node dissec-

tion

C. Laparoscopic radical nephrectomy without retroperitoneal lymph

node dissection

D. Definitive radiation and combined chemotherapy

Question 21.18. A 51-year-old man with a strong family history of prostate cancer, a nor-

mal digital rectal examination, no significant comorbid medical problems,

and a PSA of 2.9 seeks advice on prostate cancer prevention. He is sexu-

ally active in a monogamous relationship and denies any urinary or rectal

symptoms. The following are all true, EXCEPT:

A. Finasteride has been shown to decrease his risk of developing prostate

cancer.

B. Taking supplemental vitamin E has been shown to decrease his risk

of developing prostate cancer.

C. Taking finasteride will decrease the PSA.

D. 8q24 polymorphisms have been identified as risk alleles in patients

such as this.

Questions

21.19.–21.20.

A 71-year-old white man with a history of hypertension, hyperlipi-

demia, coronary artery disease, and prior angioplasty with stent

placement, but no prior myocardial infarction, is noted to have a increase

in his PSA from 3.0 to 3.9 ng/mL and then to 4.6 ng/mL over 19 months.

He is a semiretired accountant, swims actively three times per week, and

helps care for his mildly demented 95-year-old father. General physical

examination is unremarkable; a rectal examination reveals a mildly

enlarged prostate gland without any palpable nodules.