Prostate Cancer

1. Which of the following IS NOT a contra-indication for brachytherapy?

Α. Prostate size 90cm3

Β. Clinical stageΤ3α


D. Gleason Score 9(4+5)

Ε. None of the above

F.  Β and C


2. Which of the following factors DOES NOT AFFECT survival rate after prostate cancer therapy?


Β. Type of therapy

C. Clinical stage

D. Age

Ε.  Β and D

F.  Α and Β


3. Which of the following statements is FALSE?

Α. Preservation of erection capacity after 24-month brachytherapy is > 80%.

Β. There is no need for PDE5i following brachytherapy.

C. A patient with PSA>20ng/ml is not a good candidate for brachytherapy.

D. The 12-year disease-specific survival rate is > 90%.

Ε.  Β and D


4. With regard to urinary symptoms after brachytherapy, which of the following is FALSE?

Α. Post-brachytherapy incontinence is very common.

Β. More than 90% of patients present increase of IPSS within the first months following brachyterapy

C. Bladder-neck resection before brachytherapy may improve IPSS. 

D. None of the above


5. In a patient with T1 prostate cancer and survival expectancy over 10 years, radical prostatectomy: 

Α. provides cure    

Β. improves quality of life

C. increases the survival rate     

D. reduces the risk for metastasis

Ε. C and D

F. B and C


6. Which therapeutic method for localized prostate cancer is more effective according to literature? 

Α. Radical prostatectomy                        

Β. Radical external radiation

C. HDR  brachytherapy    

D. LDR brachytherapy


7. The continuously increasing development of technology and know-how upon radical prostatectomy has led to:

Α. reduction of immediate complications         

Β. reduction of  long-term complications

C. reduction of intraoperative complications        

D. better control of the disease

Ε. All the above                          

F. None of the above


8. Post-brachytherapy orthorrhagia occurs in:

Α. 20% of patients                           

Β. 15% of patients  

C. 10% of patients                             

D. 5% of patients  

Ε. 3% of patients                                 

F. 0%


9. Urinary Incontinence is NOT a long-term complication of brachytherapy. 

Α. True                                     

Β. False


10. Which of the following statements is FALSE?

Α. Anastomotic urine leak is less likely in robotic-assisted laparoscopic radical prostatectomy.

Β. Checking for anastomotic leak tightness has no prognostic value.

C. The fewer sutures in the anastomosis, the more chances for urine leak.

D. Β and C

Ε. All the above


11. Robotic radical prostatectomy:

Α. gives better functional result than open radical prostatectomy 

Β. gives the same functional results as open radical prostatectomy

C. should be abandoned as a procedure, for it has very high cost

D. is the only technique that is allowed today to be used in all cases 


12. Which finding from prostate biopsy is the most useful to predict extraprostatic expansion of cancer?

Α. Degree of differentiation

Β. Number of positive biopsies

C. Perineural invasion

D. All the above


13. According to TNM 2009, microscopic bladder neck invasion is classified as: 

Α. Τ4

Β. Τ3α

C. Τ3β

D. Τ2β


14. Patients with Τ3 prostate adenocarcinoma present lymph-node metastasis in:

Α. 10%

Β. 40%

D. 60%

D. 70%


15. The risk for lymph-node metastasis in a patient with prostate cancer depends mainly on the: 

Α. age

Β. stage

C. Gleason score

D. B and C


16. Which of the following statement is TRUE? 

Α. Prostate cancer T3 is more rare than stage T2.

Β. Prostate cancer T3 is successfully treated with radiation therapy.

C. Prostate cancer T3 progresses within 5 years after radical prostatectomy in  40% of cases.

D. Prostate cancer T3 is successfully treated with radical prostatectomy.


 17. Which histological pathological finding/s from the radical prostatectomy specimen can predict the presence of latent metastatic disease? 

Α. Positive surgical margins

Β. Seminal vesicle invasion

C. Lymph-node invasion

D. B and C

Ε. A and B


18. For patients who presented biochemical relapse after radical prostatectomy, which of the following factors are related more to local relapse than to remote metastasis? 

Α. First measurable PSA value 6 months after surgery, Gleason score >7,  pathological stage Τ3

Β. Age below 70y.o. at the time of relapse, first measurable PSA value < 2 ng/ml, Gleason score <

C. Histological absence of seminal vesicles and lymph-nodes, Gleason score <5, first measurable PSA value one year after surgery, PSA doubling-time (PSADT) >6 months

D. Pathological stage Τ2, Gleason score 8 to 10, negative bone scintigram

Ε. First measurable PSA value 4 months after surgery, negative biopsy of prostatic bed, PSA doubling-time (PSADT) <3 months 


19. In clinically localized prostate cancer, what are the chances for biochemical relapse-free survival within 5 years?

Α.. 0-10%

Β. 20-30%

C. 40-50%

D. 60-70%

Ε. 70-80%


20. According to Partin's Tables, a patient with PSA 7.4 before biopsy, Gleason score 3+4=7 at biopsy and negative digital examination (Τ1c) before biopsy has all following risks  APART FROM:

Α. 49% risk  for localized disease inside the gland

Β. 40% risk for  focal invasion of the capsule

C. 22% risk for pelvic lymph-node invasion

D. 97% risk for in situ/ localized disease

Ε. 8% risk for seminal vesicle invasion


21. All the following are prognostic factors for radiotherapy salvage after radical prostatectomy, APART FROM: 

Α.  PSA levels before radiation therapy

Β. PSA doubling time (< 10-12 months)

C. time until the occurrence of biochemical relapse (< 2-3 years)

D. the patient's age


22. Which of the following statements is TRUE?

Α. Laparoscopic radical prostatectomy is a new minimally invasive method  for the treatment of prostate cancer.

Β. Robot-assisted radical prostatectomy is a well-documented radical oncological procedure that can be performed even with minimal access


23. Which of the following statements is TRUE?

Α. Laparoscopic radical prostatectomy requires high technical skills and should be performed only in Specialized Centers. 

Β. Surgical steps of the procedure have been thoroughly described and are simple and reproducible. The only problem for the disemmination of the technique is lack of training structures. 


24. In order to achieve higher neuroprotection during nerve-sparing radical prostatectomy, the periprostatic fascia (PPF) is incised:

Α. on the ventral aspect of the prostate

Β. superiorly, on the dorso-lateral aspect of the prostate

C.on the mid-lateral aspect of the prostate

D. at the apex of the prostate

Ε. at any point of the prostate - this does not seem to affect the number of nerve fibers spared.


25. During radical prostatectomy and in order to achieve a better oncological result, the surgeon will procceed to prostate dissection following the: 

A. interfascial technique

Β. intrafascial technique

C. extrafascial technique

D. posterior technique, through Denonvillier's fascia

Ε. All above techniques have the same oncological result.


26. Which of the following surgical procedures does NOT seem to play a particular role in achieving continence after radical prostatectomy?

Α. Preservation of puboprostatic ligaments

Β. Fixation of the vesico-urethral anastomosis 

C. Restoration/ preservation of puboperineal muscles 

D. At least 8 sutures for the vesicourethral anastomosis

Ε. Α and  D


27. According to the latest literature on prostate biopsy, the following is true:

Α. Aspirin administration has to be discontinued and there is need for periprostatic xylocaine infiltration. 

Β. Aspirin administration has to be discontinued. Local anesthesia does not help.

C. Aspirin administration can continue. Local application of xylocaine gel reduces pain. 

D. Aspirin has to be replaced with heparin. Local anesthesia with xylocaine gel is preferrable. 


28. Which of the following clinical factors is positively correlated with the pathoanatomical stage following salvage radical prostatectomy? 

Α. The time period since the completion of radiation therapy.

Β. The degree of malignancy at the time of biopsy.

C. PSA<10ng/ml at the time of salvage surgery.

D. The patient's age at the initial diagnosis of prostate cancer.

Ε. PSADT (PSA doubling-time)   


29.  Following radiation therapy, prostate biopsy has to be negative:  

Α. within 6 months

Β. within 12 months

C. within 18 months

D. within 30 months

Ε. None of the above  


30. One year following radiation therapy, serum PSA dropped within "normal values"  (2,5 ng/ml) and started rising again, with consecutive values 3,5 and 5,1 ng/ml within 6 months. What should be done next?   

Α. Inform the patient that radiation therapy "did not work" and recommend salvage prostatectomy and cryotherapy.

Β. Explain to the patient that his PSA is still normal and he should not worry. 

C. Inform the patient that his disease has relapsed and that increase in PSA  implicates systemic disease. 

D. None of the above.

Ε.  Α and Β  


Correct answers

1 C

9 Β

17 D


2 Ε

10 Ε

18 C

26 D

3 Β

11 Β

19 Ε

27 C

4 Α

12 D

20 C

28 C

5 Ε

13 Β

21 D

29 D

6 Α

14 Β

22 Β

30 C

7 Ε

15 D

23 Β


8 Ε

16 C

24 Β