Quick question and answer: 5 questions to understand the manifestations and diagnosis of prostate cancer

Prostate cancer is still an important cause of death worldwide.

In 2018, nearly 1.
3 million patients were diagnosed with prostate cancer.

Among male patients, prostate cancer is the second most common cancer and the fifth leading cause of death.

Early diagnosis helps to increase the success rate of treatment.

What are the manifestations of prostate cancer and what should be paid attention to when diagnosing? Let's test the following 5 questions together! 01 Although this symptom is not common in asymptomatic men who are routinely screened for prostate cancer, which of the following is the most frequently reported local symptom in prostate cancer patients? A.
Erectile dysfunction B.
Bone pain C.
Weight loss D.
Frequent urination Figure 1 Color MRI of prostate cancer Answer: D Before the prostate specific antigen (PSA) test, prostate cancer patients often have hematuria and urinary retention.
symptom.

Currently, the most common local symptoms are frequent urination (38%), decreased urine flow (23%), and urgency (10%).

 02 Regarding digital rectal examination (DRE), which of the following is correct? A.
In locally advanced disease, it can be found that the central sulcus disappears or the seminal vesicles are involved.
B.
Adenopathy is a characteristic of early prostate cancer.
C.
Nodules are more common, but it is not suspected that malignant DRE examination is not an important part of the local stage of prostate cancer.
Answer: A.
In patients with locally advanced disease, DRE usually has central sulcus disappearance or seminal vesicle involvement.

Adenopathy can occur in patients with advanced prostate cancer, but adenopathy is not a feature of early prostate cancer.

The lymph nodes are deep in the pelvis and cannot be touched by digital examination.

Nodules should be suspected of being malignant and additional examinations should be performed.

 03Which one of the following descriptions of PSA speed is correct? A.
When determining whether a prostate biopsy is necessary, the PSA speed does not need to be considered.
B.
Regardless of the patient’s age and risk status, when the PSA speed is as low as 0.
6 ng/ml/yr, the patient is usually prompted to undergo a prostate biopsy.
C.
For ＜ For a 50-year-old man, the PSA rate of 0.
75 ng/ml/yr is not a factor that needs to be considered for prostate biopsy.
D.
PSA rate ≥ 0.
6 ng/ml/yr may be an appropriate prompt for a prostate biopsy for men less than 50 years old.
Answer: D Currently, PSA speed is still a controversial topic.

Generally speaking, PSA speed ≥0.
75ng/ml/yr usually indicates the need for prostate biopsy.

However, for men <50 years of age, prostate biopsy may be more appropriate when the PSA rate is ≥0.
6ng/ml/yr.

 04In the diagnosis of prostate cancer, which patients need CT staging scan and bone scan? A.
PSA level> 4 mg/ml is an indication for male patients to undergo CT staging scan and bone scan B.
PSA level> 10 mg/ml is an indication for male patients to undergo CT staging scan and bone scan C.
Regardless of PSA level, Gleason A score of 7 may be an indication for CT staging scans and/or bone scans.
D.
In the diagnosis of prostate cancer, CT staging scans and bone scans are not required.
Answer: B When the PSA level is >10ng/ml, the histological manifestations are at high risk ( Gleason ≥ 7 points), or when the clinical examination shows advanced disease, the patient is most likely to undergo CT scan and bone scan.

CT scan is an examination method recommended by guidelines based on evidence-based evidence.

CT scans can be used to assess various bladder dilation and lymph node conditions to help patients with cancer staging, or to take lymph node sampling before considering treatment.

 It is worth noting that regardless of the patient's PSA level, patients with a Gleason score >6 at the first visit can undergo bone scans.

However, for patients with a Gleason score of less than 7 and a PSA level of less than 20 ng/ml, the value of bone scan is limited.

 05 Which of the following localized prostate cancer patients is histologically classified as high-risk? A.
≥T1-T2a stage, Gleason score ≥6 points and PSA level ≥10ng/ml B.
≥T2c stage or Gleason score 8-10 or PSA level >20ng/ml C.
≥T2b stage or Gleason score ≥5 points or PSA level >15ng/mlD.
≥T2a, Gleason score≥6 and PSA level≥10ng/ml Answer: B is to guide the treatment and prognosis of patients.
The European Society of Medical Oncology (ESMO) guidelines classify localized prostate cancer as follows: • Low risk: T1-T2a stage, Gleason score ≤ 6 points and PSA level ≤ 10 ng/ml; • Medium risk: T2b stage and/or Gleason score 7 points and/or PSA level 10-20 ng/ml; • High Risk: T2c stage or Gleason score 8-10 points or PSA level >20 ng/ml.

 ESMO further recommends that patients with intermediate or high risk use CT, MRI, choline PET/CT scan, or pelvic lymph node dissection for lymph node staging.

Intermediate or high-risk patients should also undergo technetium bone scan, chest and abdomen CT scan, whole body MRI scan, or choline PET/CT scan staging.

 Yimaitong compiled from: Kyle A.
Richards.
Fast Five Quiz: Prostate Cancer Presentation and Diagnosis.
Medscape.
January 29, 2020.