Devita, Hellman, and Rosenberg's Cancer

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

286 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 21.27. A 75-year-old man with diabetes, hypertension, and coronary artery

disease who is receiving atorvastatin, glyburide, and an angiotensin-

converting enzyme inhibitor is under surveillance after external beam

radiotherapy for a Gleason 3+3 prostate cancer that was diagnosed and

treated 10 years earlier when he was found to have a PSA of 4.3 on rou-

tine screening. His PSA level, which had been 0.2 ng/mL, has increased

to 0.3, 0.35, and then 0.40 over the period of 18 months. The MOST

appropriate therapy at this time is:

A. Androgen ablation with an LHRH agonist

B. Continued active surveillance

C. High-intensity focused ultrasound to his prostate

D. High-dose (150 mg) bicalutamide

Question 21.28. A 65-year-old man has been receiving combined androgen ablation with

leuprolide and bicalutamide for 4 years for biochemical recurrence after

radical prostatectomy. His PSA has increased from an undetectable nadir

to 1.1 ng/mL on serial measurement over the period of 6 months. The

PSA continues to increase 2 months after discontinuation of bicalutamide

to 1.5, with serum testosterone of 10 ng/mL. Bone scan and CT of the

abdomen/pelvis do not reveal any metastatic disease, and he remains

asymptomatic. Treatment options include all the following, EXCEPT:

A. Active surveillance

B. Docetaxel-based chemotherapy

C. Thalidomide

D. High-dose ketoconazole

Question 21.29. All the following statements about prostate cancer epidemiology are cor-

rect, EXCEPT:

A. There is a marked difference in mortality from prostate cancer in

different parts of the world.

B. The difference in mortality between African Americans and Cau-

casian Americans can be completely explained by socioeconomic fac-

tors.

C. Epidemiologic studies suggest a dietary or lifestyle component to

prostate cancer development.

D. There is molecular confirmation for genetic risk factors for prostate

cancer.

Question 21.30. The following statements about prostate cancer biology are all correct,

EXCEPT:

A. GSTloss is common in prostate intraepithelial neoplasia (PIN).

B. TMPRSS2 translocations juxtapose an androgen-responsive gene

promoter with a transcription factor.

C. PTEN loss is as common in PIN as in more advanced cancer.

D. NKX3.1 has been postulated to be a gatekeeper tumor suppressor.