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  #1  
Old 04-26-2012
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Question Preventing Prostatic Carcinoma!

A 58-year-old man is evaluated in the office during a routine examination. He is healthy but seeks advice on how to avoid developing prostate cancer because his father was recently diagnosed with this disease. The remainder of his medical and family history is noncontributory. The physical examination is normal.

Which of the following interventions would be most likely to decrease this patient's risk for prostate cancer?
A Annual digital rectal examination
B Annual prostate-specific antigen measurement
C Finasteride
D Five servings of fruits and vegetables daily
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Old 04-26-2012
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B. Annual PSA measurement
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Anyone else?
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Correct Answer = C

A large multicenter, randomized, placebo-controlled trial showed that finasteride, an inhibitor of 5-α-reductase that converts testosterone to dihydrotestosterone, administered at a dose of 5 mg/d for 7 years, reduces the prevalence of prostate cancer by approximately 25% (absolute risk 24.4% in the placebo group vs. 18.4% in the finasteride group; number needed to treat = 17). High-grade disease (Gleason score 7 to 10) developed in more men in the finasteride group (6.4%) than in the placebo group (5.1%); however, the Gleason tumor grading system was developed for men who were not taking antiandrogen medications, and its extrapolation to men receiving finasteride is unclear. There was no difference in prostate cancer mortality rates between the two study groups. Finasteride is associated with an increase in sexual side effects compared with placebo, including a reduced volume of ejaculate (60.4% vs. 47.3%), erectile dysfunction (67.4% vs. 61.5%), and loss of libido (65.4% vs. 59.6%). Gynecomastia is also more common (4.5% vs. 2.8%). However, finasteride is also associated with a lower incidence of urinary obstructive symptoms (12.9% vs. 15.6%). Therefore, patients who are considering preventive therapy with finasteride must consider its benefits and harms before deciding whether to begin treatment.

Screening with digital rectal examination or prostate-specific antigen measurement has not been shown to decrease prostate cancer mortality rates in controlled trials and will result in an increase, rather than a decrease, in cancer incidence. Intake of fruits and vegetables has not been shown to decrease the risk for prostate cancer, although some observational studies have suggested that some dietary constituents, such as lycopenes, are associated with a lower risk for this disease; however, these data are not consistent and have not been tested in controlled trials.

Key Point
Finasteride reduces prostate cancer prevalence by 25%.
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Old 04-26-2012
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Didn't know the answer but managed to figure it out by exclusion.

A & B are wrong since they can help in early detection but has no role in prevention of Prostatic Ca.

D is just a filler choice.

So, the only plausible choice left is C
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Quote:
Originally Posted by usmledee View Post
Correct Answer = C

A large multicenter, randomized, placebo-controlled trial showed that finasteride, an inhibitor of 5-α-reductase that converts testosterone to dihydrotestosterone, administered at a dose of 5 mg/d for 7 years, reduces the prevalence of prostate cancer by approximately 25% (absolute risk 24.4% in the placebo group vs. 18.4% in the finasteride group; number needed to treat = 17). High-grade disease (Gleason score 7 to 10) developed in more men in the finasteride group (6.4%) than in the placebo group (5.1%); however, the Gleason tumor grading system was developed for men who were not taking antiandrogen medications, and its extrapolation to men receiving finasteride is unclear. There was no difference in prostate cancer mortality rates between the two study groups. Finasteride is associated with an increase in sexual side effects compared with placebo, including a reduced volume of ejaculate (60.4% vs. 47.3%), erectile dysfunction (67.4% vs. 61.5%), and loss of libido (65.4% vs. 59.6%). Gynecomastia is also more common (4.5% vs. 2.8%). However, finasteride is also associated with a lower incidence of urinary obstructive symptoms (12.9% vs. 15.6%). Therefore, patients who are considering preventive therapy with finasteride must consider its benefits and harms before deciding whether to begin treatment.

Screening with digital rectal examination or prostate-specific antigen measurement has not been shown to decrease prostate cancer mortality rates in controlled trials and will result in an increase, rather than a decrease, in cancer incidence. Intake of fruits and vegetables has not been shown to decrease the risk for prostate cancer, although some observational studies have suggested that some dietary constituents, such as lycopenes, are associated with a lower risk for this disease; however, these data are not consistent and have not been tested in controlled trials.

Key Point
Finasteride reduces prostate cancer prevalence by 25%.
@usmledee, ur qs is gud, but i almost completed uw, so in CK there's no any screening test or any intervention which reduce mortility or early evaluate disease, sucessful screenig test only for Colon cancer(COLONOSCOPY), breast(MAMMOGRAPHY), and Cervical cancer(pap smear), when ever if u seen any option other then three always select answer which shows no any benefit, so finastride in prostate may b use but i havent read this in ck course.
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Quote:
Originally Posted by usmlepak View Post
@usmledee, ur qs is gud, but i almost completed uw, so in CK there's no any screening test or any intervention which reduce mortility or early evaluate disease, sucessful screenig test only for Colon cancer(COLONOSCOPY), breast(MAMMOGRAPHY), and Cervical cancer(pap smear), when ever if u seen any option other then three always select answer which shows no any benefit, so finastride in prostate may b use but i havent read this in ck course.
Check out this link for the entire study that was done in 2003 on Finesteride...

http://www.cancer.gov/newscenter/qa/2008/PCPTQandA#a1

Study Results*

What were the initial results of the PCPT?

The PCPT was the first study to show that a drug can reduce a man's chances of developing prostate cancer. Men randomized to take finasteride were 25 percent less likely to develop prostate cancers than men in the placebo group.
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Old 04-27-2012
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as A and B options are only screening tests. finestride is 5alpha reductase inhibitor that prevents conversion of testosterone into DHT so it prevents development of prostate cancer. option C was just a filler as NOVOBIOCIN said..
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