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Chapter 14. Prostate Cancer

A 52-year-old man has been recently diagnosed with prostate cancer. 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.

HH is a 52-year-old African American man with a family history of prostate cancer who presents to his primary care physician for his annual examination. He has a past medical history of hypertension. He has no relevant social history. His father passed away from prostate cancer at the age of 65. He asks about prostate cancer screening. According to the United States Preventive Services Task Force (USPSTF), which of the following is the most appropriate course of action?

a. Recommend that the patient checks back in 3 years, because he is not yet eligible for prostate cancer screening due to his age being <55.

b. He should be screened as all men should receive a digital rectal exam (DRE) and prostate specific antigen (PSA) screen starting at age 50.

c. Individualized, informed decision-making regarding screen for prostate cancer due to his risk level.

d. Explain to the patient that he is not eligible due to his advanced age and comorbidities, as his life expectancy is likely less than 10 years.

Answer c is correct. Shared decision-making is recommended for men beginning at age 45 for patients who are high risk (African American or strong ...

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