ESMO Guidelines for Prostate Cancer
Management Exam Questions And
Answers
/. What is the recommendation regarding prostate cancer testing in asymptomatic men
with a life expectancy of less than 10 years? - Answer-✅Testing should not be done in
these men.
/.What age group is recommended for population-based screening using PSA testing? -
Answer-✅Men aged between 55 and 69 years.
/.What was the result of the European screening trial after a median follow-up of 16
years? - Answer-✅It demonstrated a 25% relative reduction in prostate cancer
mortality.
/.How many men needed to be invited for screening to prevent one death from prostate
cancer? - Answer-✅570 men.
/.What PSA levels indicate an increased risk of prostate cancer metastasis or death at
ages 40 and 60? - Answer-✅PSA >1 ng/ml at 40 years or >2 ng/ml at 60 years.
/.What factors are related to the risk of clinically significant prostate cancer? - Answer-
✅Age, ethnicity, family history, PSA level, free/total PSA ratio, and findings on digital
rectal examination.
/.What imaging technique is recommended before a prostate biopsy? - Answer-✅Multi-
parametric magnetic resonance imaging (mpMRI).
/.What are the advantages of targeted transperineal biopsies compared to systematic
transrectal biopsies? - Answer-✅Increased detection rate of clinically significant
prostate cancer, decreased detection rate of clinically insignificant prostate cancer, and
fewer adverse events.
/.What should be done when mpMRI is positive (PI-RADS >3)? - Answer-✅Targeted
systematic biopsy should be performed.
/.What should be done when mpMRI is negative (PI-RADS <2) and clinical suspicion of
prostate cancer is low? - Answer-✅The biopsy can be omitted.
,/.What is the recommendation regarding population-based PSA screening for prostate
cancer? - Answer-✅It reduces prostate cancer mortality but is associated with over-
diagnosis and overtreatment, so it is not recommended.
/.Who can be offered early PSA testing? - Answer-✅Men >50 years, men >45 years
with a family history of prostate cancer, African-Americans >45 years, and BRCA1/2
carriers >40 years.
/.What should be used to confirm the indication for biopsy in men with elevated PSA? -
Answer-✅A prostate cancer risk calculator and/or mpMRI.
/.What is the significance of the ESMO Guidelines Committee in the context of prostate
cancer? - Answer-✅They provide clinical practice guidelines for diagnosis, treatment,
and follow-up of prostate cancer.
/.What is the impact of baseline PSA testing followed by risk-adapted follow-up? -
Answer-✅It can be offered to certain high-risk groups to monitor prostate cancer risk.
/.What is the role of digital rectal examination in prostate cancer risk assessment? -
Answer-✅It is one of the factors considered in assessing the risk of clinically significant
prostate cancer.
/.What is the purpose of using risk calculators in prostate cancer diagnosis? - Answer-
✅To incorporate various risk factors for better assessment of prostate cancer risk.
/.What is the recommendation for men with a family history of prostate cancer regarding
PSA testing? - Answer-✅They should be offered early PSA testing starting at age 45.
/.What does the term 'over-treatment' refer to in the context of prostate cancer
screening? - Answer-✅It refers to unnecessary treatments resulting from over-
diagnosis due to screening.
/.What is the significance of the PI-RADS score in mpMRI? - Answer-✅It helps
determine the likelihood of clinically significant prostate cancer.
/.What is the clinical significance of a PSA level in prostate cancer screening? - Answer-
✅It helps assess the risk of prostate cancer and guide further diagnostic steps.
/.What is the recommended follow-up for men with elevated PSA levels? - Answer-
✅Risk-adapted follow-up based on individual risk factors.
/.What is the importance of the ESMO Guidelines Committee's updates? - Answer-
✅They ensure that clinical practice guidelines reflect the latest research and evidence.
,/.What type of biopsy is recommended over transrectal ultrasound-guided biopsies for
prostate cancer? - Answer-✅Transperineal biopsies.
/.What should each biopsy be evaluated according to? - Answer-✅The International
Society of Urological Pathology Consensus recommendations.
/.What factors should be considered when deciding to biopsy for prostate cancer? -
Answer-✅PSA level, MRI results, DRE findings, ethnicity, age, comorbidities, free/total
PSA, history of previous biopsy, and patient values.
/.What is the classification for low-risk prostate cancer? - Answer-✅T1/2, Gleason score
(GS) ≤ 6, PSA ≤ 10.
/.What imaging is required for men with intermediate-risk prostate cancer? - Answer-
✅MRI or CT (abdomen and pelvis) and bone scan.
/.What imaging is required for men with high-risk prostate cancer? - Answer-✅CT
(chest, abdomen, and pelvis) and bone scan.
/.What are the treatment options for low-risk localized prostate cancer? - Answer-
✅Active surveillance, brachytherapy, radical prostatectomy (RP), and radical
radiotherapy (RT).
/.What are the treatment options for intermediate-risk localized prostate cancer? -
Answer-✅Radical prostatectomy (RP), radical RT with neoadjuvant androgen
deprivation therapy (ADT), brachytherapy, and active surveillance.
/.What are the treatment options for high-risk localized prostate cancer? - Answer-
✅Long-term ADT + radical RT with neoadjuvant docetaxel, RP + pelvic
lymphadenectomy.
/.What is the management strategy for locally advanced prostate cancer? - Answer-
✅Neoadjuvant ADT + radical RT + adjuvant ADT with neoadjuvant docetaxel, RP +
pelvic lymphadenectomy.
/.What treatments are available for hormone-naive metastatic prostate cancer? -
Answer-✅ADT + abiraterone, ADT + docetaxel, ADT + enzalutamide, ADT +
apalutamide, RT for low volume, ADT alone for frail patients.
/.What are the first-line treatments for castration-resistant prostate cancer (CRPC)? -
Answer-✅Abiraterone, docetaxel, enzalutamide, and radium-223 (223Ra) for patients
unfit for other treatments.
, /.What are the second-line treatments for CRPC after docetaxel? - Answer-
✅Abiraterone, cabazitaxel, enzalutamide, and radium-223 (223Ra).
/.What are the imaging modalities with better sensitivity and specificity for staging
prostate cancer? - Answer-✅Whole-body MRI, choline-PET-CT, and PSMA-PET-CT.
/.What is the recommendation regarding the use of novel imaging techniques for
localized disease? - Answer-✅Patients should not be denied radical local treatment
solely because metastatic lesions are identified on novel imaging techniques.
/.What is the importance of discussing treatment options with patients? - Answer-
✅Patients should be informed of the benefits and harms of different treatment options.
/.What is the role of MRI in prostate cancer management? - Answer-✅MRI provides T
staging and can inform surgical technique.
/.What is the significance of the Gleason score in prostate cancer? - Answer-✅It is used
to assess the aggressiveness of prostate cancer.
/.What does ADT stand for in prostate cancer treatment? - Answer-✅Androgen
deprivation therapy.
/.What is the purpose of pelvic lymphadenectomy in high-risk prostate cancer? -
Answer-✅To assess and manage potential lymph node involvement.
/.What is the role of radium-223 (223Ra) in prostate cancer treatment? - Answer-✅It is
used for patients with bone-only metastases who are unfit for other treatments.
/.What are the key components of the diagnostic work-up for prostate cancer? - Answer-
✅CT, DRE, GS, mpMRI, MRI, PET, and PSA.
/.What is the consensus on the optimum management of localized prostate cancer? -
Answer-✅There is no consensus; patients should be offered consultations with both
urologists and radiation oncologists.
/.What are potential side effects of prostate cancer treatment? - Answer-✅Sexual
dysfunction, infertility, bowel, and urinary problems.
/.What is watchful waiting in the context of prostate cancer treatment? - Answer-✅A
strategy involving delayed hormone therapy for symptomatic progression in men who
are not suitable for or unwilling to undergo curative treatment.
Management Exam Questions And
Answers
/. What is the recommendation regarding prostate cancer testing in asymptomatic men
with a life expectancy of less than 10 years? - Answer-✅Testing should not be done in
these men.
/.What age group is recommended for population-based screening using PSA testing? -
Answer-✅Men aged between 55 and 69 years.
/.What was the result of the European screening trial after a median follow-up of 16
years? - Answer-✅It demonstrated a 25% relative reduction in prostate cancer
mortality.
/.How many men needed to be invited for screening to prevent one death from prostate
cancer? - Answer-✅570 men.
/.What PSA levels indicate an increased risk of prostate cancer metastasis or death at
ages 40 and 60? - Answer-✅PSA >1 ng/ml at 40 years or >2 ng/ml at 60 years.
/.What factors are related to the risk of clinically significant prostate cancer? - Answer-
✅Age, ethnicity, family history, PSA level, free/total PSA ratio, and findings on digital
rectal examination.
/.What imaging technique is recommended before a prostate biopsy? - Answer-✅Multi-
parametric magnetic resonance imaging (mpMRI).
/.What are the advantages of targeted transperineal biopsies compared to systematic
transrectal biopsies? - Answer-✅Increased detection rate of clinically significant
prostate cancer, decreased detection rate of clinically insignificant prostate cancer, and
fewer adverse events.
/.What should be done when mpMRI is positive (PI-RADS >3)? - Answer-✅Targeted
systematic biopsy should be performed.
/.What should be done when mpMRI is negative (PI-RADS <2) and clinical suspicion of
prostate cancer is low? - Answer-✅The biopsy can be omitted.
,/.What is the recommendation regarding population-based PSA screening for prostate
cancer? - Answer-✅It reduces prostate cancer mortality but is associated with over-
diagnosis and overtreatment, so it is not recommended.
/.Who can be offered early PSA testing? - Answer-✅Men >50 years, men >45 years
with a family history of prostate cancer, African-Americans >45 years, and BRCA1/2
carriers >40 years.
/.What should be used to confirm the indication for biopsy in men with elevated PSA? -
Answer-✅A prostate cancer risk calculator and/or mpMRI.
/.What is the significance of the ESMO Guidelines Committee in the context of prostate
cancer? - Answer-✅They provide clinical practice guidelines for diagnosis, treatment,
and follow-up of prostate cancer.
/.What is the impact of baseline PSA testing followed by risk-adapted follow-up? -
Answer-✅It can be offered to certain high-risk groups to monitor prostate cancer risk.
/.What is the role of digital rectal examination in prostate cancer risk assessment? -
Answer-✅It is one of the factors considered in assessing the risk of clinically significant
prostate cancer.
/.What is the purpose of using risk calculators in prostate cancer diagnosis? - Answer-
✅To incorporate various risk factors for better assessment of prostate cancer risk.
/.What is the recommendation for men with a family history of prostate cancer regarding
PSA testing? - Answer-✅They should be offered early PSA testing starting at age 45.
/.What does the term 'over-treatment' refer to in the context of prostate cancer
screening? - Answer-✅It refers to unnecessary treatments resulting from over-
diagnosis due to screening.
/.What is the significance of the PI-RADS score in mpMRI? - Answer-✅It helps
determine the likelihood of clinically significant prostate cancer.
/.What is the clinical significance of a PSA level in prostate cancer screening? - Answer-
✅It helps assess the risk of prostate cancer and guide further diagnostic steps.
/.What is the recommended follow-up for men with elevated PSA levels? - Answer-
✅Risk-adapted follow-up based on individual risk factors.
/.What is the importance of the ESMO Guidelines Committee's updates? - Answer-
✅They ensure that clinical practice guidelines reflect the latest research and evidence.
,/.What type of biopsy is recommended over transrectal ultrasound-guided biopsies for
prostate cancer? - Answer-✅Transperineal biopsies.
/.What should each biopsy be evaluated according to? - Answer-✅The International
Society of Urological Pathology Consensus recommendations.
/.What factors should be considered when deciding to biopsy for prostate cancer? -
Answer-✅PSA level, MRI results, DRE findings, ethnicity, age, comorbidities, free/total
PSA, history of previous biopsy, and patient values.
/.What is the classification for low-risk prostate cancer? - Answer-✅T1/2, Gleason score
(GS) ≤ 6, PSA ≤ 10.
/.What imaging is required for men with intermediate-risk prostate cancer? - Answer-
✅MRI or CT (abdomen and pelvis) and bone scan.
/.What imaging is required for men with high-risk prostate cancer? - Answer-✅CT
(chest, abdomen, and pelvis) and bone scan.
/.What are the treatment options for low-risk localized prostate cancer? - Answer-
✅Active surveillance, brachytherapy, radical prostatectomy (RP), and radical
radiotherapy (RT).
/.What are the treatment options for intermediate-risk localized prostate cancer? -
Answer-✅Radical prostatectomy (RP), radical RT with neoadjuvant androgen
deprivation therapy (ADT), brachytherapy, and active surveillance.
/.What are the treatment options for high-risk localized prostate cancer? - Answer-
✅Long-term ADT + radical RT with neoadjuvant docetaxel, RP + pelvic
lymphadenectomy.
/.What is the management strategy for locally advanced prostate cancer? - Answer-
✅Neoadjuvant ADT + radical RT + adjuvant ADT with neoadjuvant docetaxel, RP +
pelvic lymphadenectomy.
/.What treatments are available for hormone-naive metastatic prostate cancer? -
Answer-✅ADT + abiraterone, ADT + docetaxel, ADT + enzalutamide, ADT +
apalutamide, RT for low volume, ADT alone for frail patients.
/.What are the first-line treatments for castration-resistant prostate cancer (CRPC)? -
Answer-✅Abiraterone, docetaxel, enzalutamide, and radium-223 (223Ra) for patients
unfit for other treatments.
, /.What are the second-line treatments for CRPC after docetaxel? - Answer-
✅Abiraterone, cabazitaxel, enzalutamide, and radium-223 (223Ra).
/.What are the imaging modalities with better sensitivity and specificity for staging
prostate cancer? - Answer-✅Whole-body MRI, choline-PET-CT, and PSMA-PET-CT.
/.What is the recommendation regarding the use of novel imaging techniques for
localized disease? - Answer-✅Patients should not be denied radical local treatment
solely because metastatic lesions are identified on novel imaging techniques.
/.What is the importance of discussing treatment options with patients? - Answer-
✅Patients should be informed of the benefits and harms of different treatment options.
/.What is the role of MRI in prostate cancer management? - Answer-✅MRI provides T
staging and can inform surgical technique.
/.What is the significance of the Gleason score in prostate cancer? - Answer-✅It is used
to assess the aggressiveness of prostate cancer.
/.What does ADT stand for in prostate cancer treatment? - Answer-✅Androgen
deprivation therapy.
/.What is the purpose of pelvic lymphadenectomy in high-risk prostate cancer? -
Answer-✅To assess and manage potential lymph node involvement.
/.What is the role of radium-223 (223Ra) in prostate cancer treatment? - Answer-✅It is
used for patients with bone-only metastases who are unfit for other treatments.
/.What are the key components of the diagnostic work-up for prostate cancer? - Answer-
✅CT, DRE, GS, mpMRI, MRI, PET, and PSA.
/.What is the consensus on the optimum management of localized prostate cancer? -
Answer-✅There is no consensus; patients should be offered consultations with both
urologists and radiation oncologists.
/.What are potential side effects of prostate cancer treatment? - Answer-✅Sexual
dysfunction, infertility, bowel, and urinary problems.
/.What is watchful waiting in the context of prostate cancer treatment? - Answer-✅A
strategy involving delayed hormone therapy for symptomatic progression in men who
are not suitable for or unwilling to undergo curative treatment.
