Devita, Hellman, and Rosenberg's Cancer

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

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

Question 21.19. The MOST correct statement about this case is:

A. Biopsy should be discussed because the PSA increase is>0.75 ng/

mL/yr.

B. Biopsy should not be discussed because PSA is normal for his age.

C. Biopsy should not be discussed because his expected survival makes

treatment not worthwhile, even if prostate cancer is discovered.

D. Biopsy should be discussed because the PSA is>4 ng/mL.

E. The free-to-total PSA ratio will determine the need for biopsy.

Question 21.20. Biopsy reveals Gleason 8 prostate cancer in six of six cores. CT scan of

the abdomen and pelvis and bone scan are unremarkable. The MOST

appropriate therapy is:

A. Radical retropubic prostatectomy

B. Three-dimensional conformal radiotherapy with concomitant andro-

gen ablation

C. Interstitial radiotherapy with 125I

D. All of the above

Question 21.21. After discussion with a radiation oncologist and a urologist, the patient

elects to undergo combined androgen ablation and external beam radia-

tion therapy. The androgen ablation is administered before the radiation

therapy and continued for 3 months thereafter. Radiotherapy is compli-

cated only by a mild diarrhea that resolves once the radiation therapy

is complete. The PSA nadirs at 1.2 ng/mL; however, 9 months after his

last dose of the luteinizing hormone-releasing hormone (LHRH) agonist,

the PSA increases to 2.4 ng/mL and then to 3.6 ng/mL 1 month later.

Testosterone level is normal at 350 ng/mL. The MOST appropriate next

therapeutic and/or diagnostic maneuver is:

A. Perform MRI of the pelvis to assess for local recurrence

B. Reinitiate androgen ablation

C. Refer the patient to a urologist for salvage prostatectomy

D. Initiate docetaxel-based chemotherapy

Question 21.22. The patient is treated with an LHRH agonist along with the antiandrogen

bicalutamide. PSA declines to 0.8 ng/mL, but after 10 months, the PSA

begins to slowly increase to a value of 3.7. He continues to feel well and

has minimal urinary symptoms, no bone pain, and no weight loss. The

MOST appropriate therapy at this point is:

A. Docetaxel-based chemotherapy

B. Discontinuing the antiandrogen bicalutamide

C. Hospice care

D. Radionuclide therapy with strontium-98 (Metastron)