Surgery

Prostate Cancer

Q: Which zone of the prostate is most commonly associated with prostate cancer?

The peripheral zone accounts for approximately 70% of prostate cancers. This is clinically relevant because it is the zone most accessible to digital rectal examination (DRE).

Q: What is the normal PSA cutoff value for men under 50 years of age?

Age-specific PSA cutoffs are used, with <2.5 ng/mL being normal for men under 50 years. The cutoffs increase with age: <3.5 for 50-60 years and <4.5 for those over 60.

Q: Which genetic alteration promotes oncogenic transcription in prostate cancer?

TMPRSS2-ERG fusion promotes oncogenic transcription and is one of the most common genetic alterations in prostate cancer. PTEN loss, TP53, and RB1 mutations are associated with aggressive, androgen-independent forms.

Q: What PI-RADS score on multiparametric MRI is considered suspicious for malignancy?

A PI-RADS score of ≥3 is considered suspicious for malignancy on multiparametric MRI. PI-RADS scoring ranges from 1-5 and helps determine the need for biopsy.

Q: How many cores minimum should be obtained during a TRUS-guided systematic biopsy?

TRUS-guided systematic biopsy requires a minimum of 12 cores, distributed across the prostate zones. This ensures adequate sampling to detect cancer.

Prostate cancer is an adenocarcinoma arising primarily from the peripheral zone of the prostate gland, driven by androgen dependence and genetic alterations such as TMPRSS2-ERG fusion, making it the most common non-cutaneous malignancy in men. Its clinical significance lies in the spectrum from indolent localized disease detectable through PSA screening and digital rectal examination to aggressive metastatic forms causing bone pain, cord compression, and significant morbidity. Medical students must understand the Gleason grading system and TNM staging as these directly guide management decisions ranging from active surveillance for low-risk disease to androgen deprivation therapy and chemotherapy for advanced cases, while also recognizing the balance between early detection benefits and the risks of overdiagnosis and treatment-related complications such as incontinence and erectile dysfunction.

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1. Which zone of the prostate is most commonly associated with prostate cancer?

2. What is the normal PSA cutoff value for men under 50 years of age?

3. Which genetic alteration promotes oncogenic transcription in prostate cancer?

4. What PI-RADS score on multiparametric MRI is considered suspicious for malignancy?

5. How many cores minimum should be obtained during a TRUS-guided systematic biopsy?

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Prostate Cancer

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