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Prostate cancer Wiki2Web Clarity Challenge

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Study Guide: Prostate Cancer: Etiology, Diagnosis, and Management

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Prostate Cancer: Etiology, Diagnosis, and Management Study Guide

Etiology and Epidemiology

Prostate cancer is characterized by uncontrolled cell growth in the prostate gland, which is located above the bladder in the male reproductive system.

Answer: False

Explanation: The prostate gland is situated below the bladder, not above it, in the male reproductive system.

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The medical specialties primarily involved in prostate cancer care are oncology, focusing on cancer treatment, and urology, which addresses the urinary tract and male reproductive organs.

Answer: True

Explanation: Oncology specializes in cancer treatment, and urology focuses on the urinary tract and male reproductive organs, both being central to prostate cancer care.

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The risk of prostate cancer significantly decreases with advancing age, with most cases occurring in men under 40.

Answer: False

Explanation: The risk of prostate cancer significantly increases with advancing age, with most cases occurring in men over 60.

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A family history of prostate cancer and older age are recognized as primary risk factors for the disease.

Answer: True

Explanation: Older age, family history, and race are indeed identified as primary risk factors for prostate cancer.

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Five-year survival rates for prostate cancer are consistently high, ranging from 90% to 99% regardless of the stage at diagnosis.

Answer: False

Explanation: Five-year survival rates for prostate cancer vary significantly with the stage at diagnosis, ranging from 30% to 99%, with lower rates for advanced disease.

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Globally, prostate cancer is the leading cause of cancer and cancer death in men, with over 2 million cases diagnosed annually.

Answer: False

Explanation: Globally, prostate cancer is the second-leading cause of cancer and cancer death in men, with approximately 1.2 million cases diagnosed annually.

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5α-reductase inhibitors are approved by regulatory agencies specifically for the prevention of prostate cancer.

Answer: False

Explanation: While 5α-reductase inhibitors have been shown to reduce the total incidence of prostate cancer, no drug or vaccine is currently approved by regulatory agencies specifically for its prevention.

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Where is the prostate gland located in the male reproductive system?

Answer: Below the bladder

Explanation: The prostate gland is a component of the male reproductive system, situated directly below the bladder.

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Which medical specialty primarily focuses on cancer treatment, including prostate cancer?

Answer: Oncology

Explanation: Oncology is the medical specialty dedicated to the study, diagnosis, and treatment of cancer, including prostate cancer.

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The usual onset of prostate cancer occurs in men over what age?

Answer: 40

Explanation: The usual onset of prostate cancer begins in men over the age of 40, with risk increasing significantly with age.

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Which of the following is NOT identified as a primary risk factor for prostate cancer?

Answer: Regular vigorous exercise

Explanation: Older age, family history, and race are primary risk factors, whereas regular vigorous exercise is linked to a reduced risk.

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What is the range of five-year survival rates for prostate cancer, varying with the stage at diagnosis?

Answer: 30% to 99%

Explanation: Five-year survival rates for prostate cancer can range broadly from 30% to 99%, depending on the stage at which the disease is diagnosed.

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Approximately how many individuals die from prostate cancer globally each year?

Answer: Over 350,000

Explanation: Globally, over 350,000 individuals succumb to prostate cancer annually, making it the second-leading cause of cancer death in men.

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What is the approximate lifetime risk of a man being diagnosed with prostate cancer?

Answer: One in eight

Explanation: Approximately one in eight men will receive a diagnosis of prostate cancer during their lifetime.

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Which of the following regions has the highest incidence of prostate cancer?

Answer: North America

Explanation: North America, along with Australia, Europe, and New Zealand, reports some of the highest incidences of prostate cancer globally.

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Pathophysiology and Molecular Biology

Prostate cancer commonly metastasizes to the lungs and liver, rarely affecting bones.

Answer: False

Explanation: Prostate cancer commonly metastasizes to the bones and nearby lymph nodes, not typically the lungs and liver.

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Over 95% of prostate cancers are classified as squamous-cell carcinoma, resembling squamous epithelial cells.

Answer: False

Explanation: Over 95% of prostate cancers are classified as adenocarcinomas, which resemble gland tissue, not squamous-cell carcinoma.

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Prostate cancer is caused by the accumulation of genetic mutations in prostate cells that disrupt normal cellular processes.

Answer: True

Explanation: Prostate cancer originates from the accumulation of genetic mutations in prostate cells, which interfere with normal cellular regulation, leading to uncontrolled growth.

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Most prostate tumors originate in the central zone of the prostate gland.

Answer: False

Explanation: Most prostate tumors originate in the peripheral zone, which is the outermost part of the prostate gland.

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Which body part is a common site for prostate cancer to metastasize?

Answer: Bones

Explanation: Prostate cancer frequently metastasizes to the bones, particularly in the pelvis, hips, spine, ribs, head, and neck.

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What is the most common type of prostate cancer, resembling gland tissue?

Answer: Adenocarcinoma

Explanation: Adenocarcinoma is the most prevalent type of prostate cancer, accounting for over 95% of cases, and is characterized by its resemblance to gland tissue.

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What is the fundamental cellular cause of prostate cancer?

Answer: Accumulation of genetic mutations in prostate cells.

Explanation: The fundamental cellular cause of prostate cancer is the accumulation of genetic mutations within prostate cells, leading to dysregulation of cell growth and division.

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In which zone of the prostate gland do most tumors originate?

Answer: Peripheral zone

Explanation: The majority of prostate tumors originate in the peripheral zone, which constitutes the outermost region of the prostate gland.

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Prostatic Intraepithelial Neoplasia (PIN) is described as:

Answer: A clump of dysregulated cells that can progress into tumors.

Explanation: Prostatic Intraepithelial Neoplasia (PIN) refers to a cluster of dysregulated prostate cells that possess the potential to develop into full-fledged cancerous tumors.

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The gene fusion between TMPRSS2 and the oncogene ERG is found in what percentage of early prostate tumors?

Answer: Up to 60%

Explanation: The gene fusion involving TMPRSS2 and the oncogene ERG is a common genomic alteration, detected in up to 60% of early prostate tumors.

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Compared to localized disease, metastatic prostate cancer generally exhibits:

Answer: A greater number of genetic mutations, especially in DNA damage repair genes.

Explanation: Metastatic prostate cancer typically presents with a higher burden of genetic mutations compared to localized disease, particularly affecting genes involved in DNA damage repair.

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Which gene variant is associated with up to an eight-fold increased risk of prostate cancer?

Answer: BRCA2

Explanation: Variations in the BRCA2 gene are associated with the most significant increase in prostate cancer risk, potentially up to eight-fold.

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Diagnosis and Staging

Early prostate cancer commonly presents with noticeable symptoms such as erectile dysfunction and frequent urination.

Answer: False

Explanation: Early prostate cancer is typically asymptomatic; noticeable symptoms like erectile dysfunction or frequent urination usually indicate more advanced disease.

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The standard diagnostic method for prostate cancer involves a digital rectal examination (DRE) followed by a PSA blood test.

Answer: False

Explanation: The standard diagnostic method involves a PSA blood test followed by a tissue biopsy, not necessarily a DRE as the primary follow-up. DRE is a screening tool.

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Benign prostatic hyperplasia (BPH) is a cancerous enlargement of the prostate that can cause symptoms similar to prostate cancer.

Answer: False

Explanation: Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate, although it can cause urinary symptoms similar to prostate cancer.

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Elevated PSA levels in the blood definitively confirm the presence of prostate cancer, making a biopsy unnecessary.

Answer: False

Explanation: Elevated PSA levels indicate an increased risk but do not definitively confirm prostate cancer; a tissue biopsy is essential for a conclusive diagnosis.

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A Gleason score ranges from 1 to 5, with a higher score indicating a less aggressive tumor.

Answer: False

Explanation: A Gleason score ranges from 6 to 10, with a higher score indicating a more aggressive tumor that is less similar to healthy tissue.

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PSA levels above 10 ng/mL during screening indicate a low risk of prostate cancer, with less than 1 in 4 men developing the disease.

Answer: False

Explanation: PSA levels above 10 ng/mL indicate a high risk of prostate cancer, with more than half of men in this group developing the disease.

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Recent ejaculation and prostate infection can cause elevated PSA levels unrelated to cancer.

Answer: True

Explanation: Factors such as recent ejaculation, prostate infection (prostatitis), and benign prostatic hyperplasia (BPH) can all lead to elevated PSA levels without the presence of cancer.

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The Prostate Health Index (PHI) and 4K score are secondary screening blood tests used to predict aggressive prostate cancer.

Answer: True

Explanation: The Prostate Health Index (PHI) and 4K score are secondary blood tests that measure PSA subtypes and other molecules to better predict aggressive prostate cancer.

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A digital rectal examination (DRE) involves a doctor inserting a lubricated finger into the rectum to manually feel the prostate gland for lumps.

Answer: True

Explanation: The digital rectal examination (DRE) is a procedure where a doctor manually palpates the prostate gland through the rectum to detect abnormalities.

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A definitive prostate cancer diagnosis can be made solely based on elevated PSA levels without the need for a biopsy.

Answer: False

Explanation: A definitive diagnosis of prostate cancer requires a tissue biopsy to confirm the presence of cancerous cells, as elevated PSA levels alone are not conclusive.

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In the Gleason grading system, numbers from 1 to 5 are assigned to the two largest areas of cancerous tissue, then added to get a score from 2 to 10.

Answer: False

Explanation: In the Gleason grading system, numbers from 3 to 5 are assigned to the two largest areas of cancerous tissue, which are then added to yield a score ranging from 6 to 10.

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The AJCC TNM system uses T scores to describe the extent of tumor growth, with T1 indicating tumors not detectable by imaging or DRE.

Answer: True

Explanation: In the AJCC TNM system, T scores describe tumor extent, and T1 specifically refers to tumors that are not detectable by imaging or digital rectal examination.

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In the AJCC TNM system, N and M scores are continuous variables that indicate the exact number of affected lymph nodes and distant metastases.

Answer: False

Explanation: In the AJCC TNM system, N and M scores are binary ('yes' or 'no') indicators of lymph node spread and distant metastases, not continuous variables.

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Stage I prostate cancer, according to AJCC, involves localized tumors (T1 or T2), no lymph node or distant spread, a Gleason grade group of 1, and PSA levels less than 10 ng/mL.

Answer: True

Explanation: Stage I prostate cancer, as defined by the AJCC system, includes localized tumors (T1 or T2), absence of lymph node or distant spread, a Gleason grade group of 1, and PSA levels below 10 ng/mL.

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The Cambridge Prognostic Group (CPG) system is a two-stage system that directly replaces the AJCC staging for all prostate cancer cases in the UK.

Answer: False

Explanation: The Cambridge Prognostic Group (CPG) system is a five-stage system recommended in the UK, but it does not directly replace the AJCC staging for all cases; it is based on disease prognosis.

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What are the typical symptoms of early prostate cancer?

Answer: No symptoms

Explanation: Early prostate cancer is often asymptomatic, meaning it typically presents with no noticeable symptoms.

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After a PSA blood test, what is the standard diagnostic step to confirm prostate cancer?

Answer: Tissue biopsy of the prostate

Explanation: Following an elevated PSA blood test, a tissue biopsy of the prostate is the standard procedure to definitively confirm the presence of cancerous cells.

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Benign prostatic hyperplasia (BPH) is often considered in the differential diagnosis for prostate cancer because it is a:

Answer: Non-cancerous enlargement of the prostate causing similar urinary symptoms.

Explanation: Benign prostatic hyperplasia (BPH) is a non-cancerous condition that causes prostate enlargement and urinary symptoms, making it a key consideration in the differential diagnosis of prostate cancer.

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What is the primary purpose of measuring Prostate-Specific Antigen (PSA) levels in the blood during screening?

Answer: To measure a protein that can indicate an enlarged prostate, prompting further steps.

Explanation: The primary purpose of PSA screening is to detect elevated levels of this protein, which may signal an enlarged prostate due to cancer or other conditions, thereby prompting further diagnostic evaluation.

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A higher Gleason score, ranging from 6 to 10, indicates what about a prostate tumor?

Answer: It is a more dangerous tumor likely to grow faster.

Explanation: A higher Gleason score, within the range of 6 to 10, signifies a more aggressive tumor that is likely to grow more rapidly and deviate further from healthy tissue characteristics.

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A PSA level above 10 ng/mL during screening suggests what risk level for prostate cancer?

Answer: Even higher risk, with more than half of men developing cancer.

Explanation: A PSA level exceeding 10 ng/mL during screening indicates a significantly elevated risk, with more than half of men in this category likely to develop prostate cancer.

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Which of the following can cause elevated PSA levels unrelated to prostate cancer?

Answer: Recent ejaculation

Explanation: Recent ejaculation, prostate infection, and benign prostatic hyperplasia are known factors that can temporarily elevate PSA levels independently of prostate cancer.

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Which secondary screening blood test measures the unbound fraction of PSA?

Answer: 'free PSA' (the unbound fraction of PSA)

Explanation: 'Free PSA' specifically measures the unbound fraction of prostate-specific antigen in the blood, serving as a secondary screening test to assess prostate cancer risk.

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Why is a biopsy considered essential for a definitive prostate cancer diagnosis?

Answer: It enables a pathologist to confirm cancerous cells under a microscope.

Explanation: A biopsy is crucial for a definitive prostate cancer diagnosis because it provides tissue samples for microscopic examination by a pathologist, confirming the presence and characteristics of cancerous cells.

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What is the range of the final Gleason score, calculated by adding two numbers from 3 to 5?

Answer: 6 to 10

Explanation: The final Gleason score is obtained by summing two numbers, each ranging from 3 to 5, resulting in a total score between 6 and 10.

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In the AJCC TNM system, what does a T4 score indicate regarding the tumor?

Answer: Tumors that have grown into organs beyond the seminal vesicles.

Explanation: A T4 score in the AJCC TNM system signifies that the tumor has extended beyond the seminal vesicles, invading adjacent organs.

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What do N1 and M1 scores in the AJCC TNM system represent?

Answer: N1: any spread to nearby lymph nodes; M1: distant metastases.

Explanation: In the AJCC TNM system, N1 indicates the presence of any spread to nearby lymph nodes, while M1 signifies the occurrence of distant metastases.

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Which characteristic defines Stage I prostate cancer according to the AJCC system?

Answer: Localized tumors (T1 or T2) and no lymph node/distant spread

Explanation: Stage I prostate cancer, as defined by the AJCC system, is characterized by localized tumors (T1 or T2), absence of lymph node involvement (N0), and no distant metastases (M0).

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Management of Localized Disease

Active surveillance for low-risk localized prostate cancer involves immediate treatment with chemotherapy, followed by annual PSA tests.

Answer: False

Explanation: Active surveillance involves regular monitoring of the tumor without immediate treatment, typically through PSA tests, DREs, and repeat biopsies, not immediate chemotherapy.

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Intensity-modulated radiation therapy (IMRT) and brachytherapy are the two main types of radiation therapy for localized prostate cancer.

Answer: True

Explanation: Intensity-modulated radiation therapy (IMRT) and brachytherapy are indeed the two primary forms of radiation therapy employed for localized prostate cancer.

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A radical prostatectomy involves the surgical removal of only the cancerous part of the prostate, leaving the seminal vesicles intact.

Answer: False

Explanation: A radical prostatectomy involves the surgical removal of the entire prostate gland, along with the seminal vesicles and the end of the vas deferens.

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Robot-assisted surgery for prostatectomy is associated with longer hospital stays and more blood loss compared to traditional open surgery.

Answer: False

Explanation: Robot-assisted surgery for prostatectomy is associated with shorter hospital stays, less blood loss, and fewer complications compared to traditional open surgery.

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After a prostatectomy, PSA levels typically drop rapidly to very low or undetectable levels within two months.

Answer: True

Explanation: Following a prostatectomy, PSA levels are expected to decrease rapidly to very low or undetectable levels within approximately two months.

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For men with low-risk localized prostate cancer, what does 'active surveillance' primarily involve?

Answer: Regular monitoring of the tumor without immediate treatment.

Explanation: Active surveillance for low-risk localized prostate cancer entails regular monitoring of the tumor's progression through tests like PSA, DRE, and biopsies, without initiating immediate active treatment.

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Which two radiation therapy types are commonly used for localized prostate cancer?

Answer: Intensity-modulated radiation therapy (IMRT) and brachytherapy

Explanation: Intensity-modulated radiation therapy (IMRT) and brachytherapy are the two principal forms of radiation therapy utilized for localized prostate cancer.

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A potential side effect of radiation therapy for prostate cancer is:

Answer: Erectile dysfunction

Explanation: Erectile dysfunction is a recognized potential side effect of radiation therapy for prostate cancer, alongside other complications such as an increased risk of bladder cancer and radiation proctitis.

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What is removed during a radical prostatectomy?

Answer: The prostate, seminal vesicles, and end of the vas deferens.

Explanation: A radical prostatectomy involves the surgical excision of the entire prostate gland, along with the seminal vesicles and the terminal portion of the vas deferens.

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Management of Advanced and Metastatic Disease

Active surveillance, prostatectomy, and chemotherapy are among the various treatment options available for prostate cancer, depending on its stage.

Answer: True

Explanation: Active surveillance, prostatectomy, radiation therapy, hormone therapy, and chemotherapy are all recognized treatment options for prostate cancer, tailored to the disease stage.

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Symptoms of advanced prostate cancer that has spread to bones include fatigue, unexplained weight loss, and persistent back or bone pain.

Answer: True

Explanation: Advanced prostate cancer that has metastasized to bones can cause fatigue, unexplained weight loss, and persistent back or bone pain, among other symptoms.

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Androgen deprivation therapy (ADT) works by increasing the levels of male sex hormones to stimulate prostate cancer cell growth.

Answer: False

Explanation: Androgen deprivation therapy (ADT) works by reducing the levels of male sex hormones (androgens), which prostate cancer cells need for growth.

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Hot flashes, decreased sex drive, and an increased risk of diabetes are common side effects of hormone therapy for prostate cancer.

Answer: True

Explanation: Common side effects of hormone therapy include hot flashes, decreased sex drive, reduced muscle mass and bone density, fatigue, and an increased risk of diabetes and cardiovascular disease.

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Castration-resistant prostate cancer (CRPC) is an early stage of the disease where tumors respond well to standard hormone therapy.

Answer: False

Explanation: Castration-resistant prostate cancer (CRPC) is an advanced stage where metastatic tumors continue to grow despite reduced testosterone levels from hormone therapy.

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Lu-177 PSMA is a radiopharmaceutical used for CRPC tumors that are PSMA-negative, binding to and destroying healthy cells.

Answer: False

Explanation: Lu-177 PSMA is a radiopharmaceutical used for PSMA-positive CRPC tumors, binding to and destroying these cancerous cells, not healthy cells.

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Bone metastases are a primary cause of symptoms and death in advanced prostate cancer, present in about 85% of cases.

Answer: True

Explanation: Bone metastases are indeed a primary cause of symptoms and death in advanced prostate cancer, affecting approximately 85% of cases.

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Spinal cord compression from prostate cancer metastases is treated primarily with long-term NSAID use and does not require surgery or radiotherapy.

Answer: False

Explanation: Spinal cord compression from prostate cancer metastases is a serious condition treated with high-dose steroids, surgery, and radiotherapy to relieve pressure, not primarily with long-term NSAIDs alone.

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Which symptom is indicative of advanced prostate cancer that has spread to bones?

Answer: Persistent back or bone pain

Explanation: Persistent back or bone pain is a key symptom of advanced prostate cancer that has metastasized to the skeletal system.

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How does Androgen Deprivation Therapy (ADT) work for metastatic prostate cancer?

Answer: By reducing the levels of male sex hormones.

Explanation: Androgen Deprivation Therapy (ADT) functions by lowering the levels of male sex hormones (androgens), which are essential for the growth and survival of prostate cancer cells.

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Which of the following is a common side effect of hormone therapy for prostate cancer?

Answer: Hot flashes

Explanation: Hot flashes are a common side effect of hormone therapy for prostate cancer, along with decreased sex drive, reduced muscle mass, and an increased risk of metabolic conditions.

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What characterizes Castration-Resistant Prostate Cancer (CRPC)?

Answer: Metastatic tumors that continue to grow despite reduced testosterone.

Explanation: Castration-resistant prostate cancer (CRPC) is defined by the continued growth of metastatic prostate tumors even when testosterone levels are significantly reduced by hormone therapy.

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For CRPC tumors with defective DNA damage repair, which class of drugs is beneficial?

Answer: PARP inhibitors

Explanation: For castration-resistant prostate cancer (CRPC) tumors exhibiting defective DNA damage repair, PARP inhibitors are a beneficial class of targeted therapeutic agents.

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What is the primary reason bone metastases are a significant concern in advanced prostate cancer?

Answer: They are the primary cause of symptoms and death.

Explanation: Bone metastases are a major concern in advanced prostate cancer because they are present in a high percentage of cases and are the leading cause of associated symptoms and mortality.

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Historical Perspectives and Research Advances

Prostate tumors were first described in the mid-19th century, and prostatectomy was an initial primary treatment.

Answer: True

Explanation: Prostate tumors were first described in the mid-19th century, and prostatectomy was indeed an initial primary treatment for urinary obstructions.

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When were prostate tumors first described?

Answer: Mid-19th century

Explanation: Prostate tumors were initially described in the mid-19th century, with the first confirmed case reported in 1853.

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Patient-Centered Care and Special Populations

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