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Chapter 14. Prostate Cancer

A 62-year-old man with a recent diagnosis of prostate cancer presents to oncologist. His oncologist tells him that his prostate cancer has a Gleason score of 3 + 3 or 6. A prostate cancer with a Gleason score of 6 is considered:

a. Not differentiated

b. Poorly differentiated

c. Differentiated

d. Moderately differentiated

e. Well differentiated

Answer d 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), while well-differentiated tumors grow slowly (better prognosis). A Gleason score of 5 to 6 is considered moderately differentiated.

Answer a is incorrect. The term “not differentiated” is not used in the Gleason scoring system.

Answer b is incorrect. A Gleason score of 7 to 10 is considered poorly differentiated.

Answer c is incorrect. The term “differentiated” is not used alone in the Gleason scoring system.

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

JJ is a 52-year-old man with a history of BPH. His most recent DRE was normal, but last PSA was 5.1 ng/mL. JJ is concerned about getting prostate cancer and wants to discuss preventative therapy. Which of the following is true pertaining to the use of 5-α reductase inhibitors for prostate cancer prevention?

a. 5-α reductase inhibitors are approved for prostate cancer prevention.

b. 5-α reductase inhibitors increase libido.

c. 5-α reductase inhibitors decrease prostate cancer, but increase the Gleason score in patients who develop cancer.

d. 5-α reductase inhibitors increase the risk of prostate cancer.

e. 5-α reductase inhibitors can increase the PSA level.

Answer c is correct. Studies reveal 5-α reductase inhibitors reduce the rate of prostate cancer, but may increase the cancer grade (Gleason grade 7-10) in those who develop prostate cancer.

Answer a is incorrect. 5-α reductase inhibitors are not approved for prostate cancer prevention.

Answer b is incorrect. 5-α reductase inhibitors can decrease libido not increase.

Answer d is incorrect. Studies reveal 5-α reductase inhibitors reduce the rate ...

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