LWBK1006-21 LWW-Govindan-Review December 12, 2011 19:6
Chapter 21•Genitourinary Cancer 295receptor expression has been reported to be both necessary and sufficient
for the castrate-resistant state, which is likely an adaptation to prolonged
exposure to a low androgen environment. Such upregulation is not gen-
erally observed de novo and has not been linked to the development
of prostate cancer. Castration dramatically lowers testosterone, but the
levels of other androgenic steroids are sufficient to cause partial activation
of androgen receptor-mediated pathways.Answer 21.32. The answer is A.
Penile carcinoma is a rare malignancy that presents most commonly with
phimosis in an uncircumcised patient. Metastatic spread of penile car-
cinoma is via superficial inguinal lymphatics, followed by deep inguinal
lymphatics, and then to the pelvic lymphatics. Systemic metastatic dis-
ease almost never develops in the absence of pelvic lymphadenopathy.
Therefore, surgery and occasionally radiotherapy form the cornerstone of
treatment for lymph node-positive patients; however, half of the patients
with clinically palpable nodes will have inflammatory lesions only. Thus, a
course of antibiotics before any further therapy is indicated. If the nodes
persist after a course of antibiotics, biopsy and surgical dissection are
indicated. Management of patients with clinical N0 is more controver-
sial, with some authors recommending immediate lymph node dissection
and others recommending a watchful waiting approach. Pathologic risk
factors as assessed in the primary lesion may assist in decision making.
Lymphangiography before a course of antibiotics is generally not consid-
ered helpful.