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Chapter 14: Urologic Pathology of the Lower Urinary Tract, Male GU System, and Kidney

What is currently considered to be the most significant risk factor for the development of urothelial carcinoma?

A. Exposure to pesticides

B. Developmental anomalies involving the urothelial tract

C. Cigarette smoking

D. Exposure to benzene

E. Family history of urothelial carcinoma

Answer: C

Explanation: Currently about two thirds of urothelial carcinomas are associated with cigarette smoking, second only to lung cancer. Historically, arylamine exposure (including benzene) was a significant association, and indeed urothelial carcinoma was first linked to exposure to arylamine dyes in the 19th century. The other three choices have minimal to no association with urothelial carcinoma.

Which is the most common testicular cancer?

A. Seminoma

B. Choriocarcinoma

C. Yolk sac tumor

D. Embryonal carcinoma

E. Mixed germ cell tumor

Answer: E

Explanation: Mixed germ cell tumors are more common than any pure tumor. Of the pure tumors, Seminoma is the most common.

Which of the following is a true statement about serum PSA (prostate specific antigen) testing?

A. Elevated serum PSA is highly predictive of the presence of prostate cancer.

B. Serum PSA typically remains elevated after radiation of the prostate for prostate cancer.

C. Serum PSA levels usually decrease with age.

D. Prostatitis may cause elevation of PSA.

E. PSA testing is considered a very effective screening tool for prostate cancer.

Answer: D

Explanation: Elevated PSA can occur in the setting of prostatitis, benign prostatic hyperplasia, and prostate cancer. PSA screening is not considered a particularly effective screening test, since only approximately 25% of patients with an elevated PSA are shown to have cancer when biopsied, and many of these are low grade and indolent cancers. The cost-benefit ratio of PSA screening does not compare favorably with screening programs for other cancers. PSA is typically very low in young men, and slowly rises (usually due to BPH which is extremely common in middle aged and older men). Serum PSA should be undetectable after prostatectomy or radiation for prostate cancer, and thus is a useful test for cancer surveillance.

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