Devita, Hellman, and Rosenberg's Cancer

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

Chapter 21•Genitourinary Cancer 293

Answer 21.22. The answer is B.

Approximately 10% to 15% of patients receiving treatment with an

antiandrogen will experience an antiandrogen withdrawal response.

Although the majority of these responses are of brief duration, it is obvi-

ously the easiest therapeutic maneuver. Docetaxel-based chemotherapy

leads to improved survival in castrate-resistant prostate cancer, which

is generally defined as a progressive disease after androgen ablation, an

antiandrogen, and antiandrogen withdrawal. Radioactive nuclides are

occasionally useful for the palliation of diffuse bone pain but have not

been shown to have an impact on survival.

Answer 21.23. The answer is C.

Over 90% of bladder cancers in Western countries are urothelial carcino-

mas. In areas where the parasiteSchistosoma haematobiumis endemic,

squamous cell bladder carcinomas are more common.Opisthorchis viver-

riniandClonorchis sinensisare associated with cholangiocarcinoma, and

not bladder cancer.

Answer 21.24. The answer is C.

Although robotic laparoscopic prostatectomy has been touted as a less-

invasive and potentially more effective approach, there is no reliable evi-

dence that the risk of long-term complications, including impotence, is

different than that observed in patients undergoing an open procedure

with an experienced surgeon. In both groups, the incidence of impotence

is at least 25%, even in young men with good erectile function before

surgery. The risk of incontinence, when assessed by anonymized, vali-

dated quality of life instruments, is on the order of 20%. One of the most

important variables for both pathologic outcome and complications is the

surgeon’s experience.

Answer 21.25. The answer is A.

Adjuvant radiotherapy has been shown to decrease the risk of recur-

rence in patients with T3 disease. However, overall survival and clinical

metastases-free survival have not been affected by this approach. Some

have thus argued for close monitoring and salvage radiotherapy on bio-

chemical recurrence in patients such as this. Imaging tests have not been

shown to be helpful in identifying patients most likely to benefit from

adjuvant therapy, and surgical reexploration is not indicated either.

Answer 21.26. The answer is D.

Patients on long-term androgen ablation are at high risk for the devel-

opment of osteoporosis and its complications, and an osteoporotic frac-

ture must be considered in this patient before initiating any therapy for

progressive metastatic disease. If progressive disease were to be diagnosed,

ketoconazole is not an unreasonable second-line hormonal therapy, but

the addition of an antiandrogen would likely be more appropriate. In the

absence of neurologic signs or symptoms, an MRI is not necessary.