Devita, Hellman, and Rosenberg's Cancer

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

Chapter 21•Genitourinary Cancer 285

Question 21.23. Infestation with which of the following parasites is a risk factor for devel-

oping bladder cancer?

A. Clonorchis sinensis

B. Opisthorchis viverrini

C. Schistosoma haematobium

D. None of the above

Question

21.24–21.25.

51-year-old black male executive with no medical history under-

goes a routine PSA screening evaluation and is found to have a PSA of

5.5 ng/mL. Biopsy reveals a Gleason 3+3 prostate cancer in two of six

biopsy cores. After discussion with a radiation oncologist and urologist,

he elects to receive treatment with a radical retropubic prostatectomy.

Question 21.24. Which of the following statements about the surgery is TRUE?

A. Robotic laparoscopic prostatectomy is associated with a lower inci-

dence of impotence than open retropubic prostatectomy.

B. The incidence of impotence under the assumption that a bilateral

nerve sparing procedure can be performed is<10%.

C. Problems with incontinence persist in approximately 20% of patients.

D. Surgical experience has only a minimal impact on the positive margin

rate.

Question 21.25. Surgical pathology confirms a Gleason score 6 tumor in both lobes of

the prostate. There is a focal surgical positive margin. There is no evi-

dence of seminal vesicle or lymph node invasion. His postoperative PSA is

undetectable, and he has good continence. The MOST appropriate next

step is:

A. Adjuvant radiotherapy

B. Repeat surgical exploration with possible reexcision of the prostatic

bed

C. Pelvic CT scan

D. Prostascint scan

Question 21.26. The patient maintains an undetectable PSA until 8 years later (at the age

of 59 years), recurrent biochemical disease is noted. After appropriate

discussion, androgen ablation with an LHRH agonist alone is initiated,

and the PSA once again becomes undetectable. The patient maintains an

undetectable PSA while on androgen ablation for 3 years, when he devel-

ops sudden mid-back pain after lifting his grandson. There are no asso-

ciated neurologic signs or symptoms. Bone scan shows marked uptake at

the T8 vertebra, and PSA remains undetectable. The MOST appropriate

therapeutic or diagnostic maneuver is:

A. Immediate radiotherapy to T8

B. Therapy with ketoconazole, 400 mg three times daily with hydrocor-

tisone replacement

C. Spinal MRI to rule out cord compression

D. Bone densitometry to assess for osteoporosis