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Chapter 14: Prostate Cancer

A 55-year-old man was recently diagnosed with prostate cancer. His oncologist tells him that his prostate cancer has a Gleason score of 4 + 4 or 8. A prostate cancer with a Gleason score of 8 is considered:

a. Poorly differentiated

b. Differentiated

c. Moderately differentiated

d. Well differentiated

Answer a is correct. Prostate cancer can be graded systematically according to the histologic appearance of the malignant cell and then grouped into well-, moderately, or poorly differentiated grades. Gland architecture is examined and then rated on a scale of 1 (well differentiated) to 5 (poorly differentiated). Two different specimens are examined, and the score for each specimen is added. Poorly differentiated tumors grow rapidly (poor prognosis), whereas well-differentiated tumors grow slowly (better prognosis). A Gleason score of 7 to 10 is considered poorly differentiated.

Answer b is incorrect. The term "differentiated" is not used alone in the Gleason scoring system.

Answer c is incorrect. Moderately differentiated is a Gleason score of 5 to 6.

Answer d is incorrect. Well differentiated is equal to a Gleason score of 2 to 4.

BD is a 45-year-old African American man with a family history of prostate cancer who presents to his primary care physician for his annual examination. He asks about prostate cancer screening. Which of the following is the most appropriate course of action?

a. Observation because he is not eligible for prostate cancer due to his age.

b. Perform a digital rectal examination to determine the size of the prostate.

c. Draw a PSA level to rule out benign prostatic hyperplasia.

d. Perform a digital rectal examination and draw a PSA level.

Answer d is correct. Neither DRE nor PSA is sensitive or specific enough to be used alone as a screening test. Therefore, the combination of a DRE plus PSA determination is a better method in detecting prostate cancer than DRE alone.

Answer a is incorrect. If screening is to be conducted, a baseline PSA and DRE at age 40 with annual evaluations beginning at age 50 to all men of normal risk with a 10-year or greater life expectancy is recommended. Men with an increased risk of prostate cancer, including men of African American ancestry and men with a family history of prostate cancer, may begin screening earlier at age 40 to 45. The patient is eligible for screening because he is at high risk due to ...

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