Prostate cancer is one of the most common malignancies in men, with a treatment landscape that is heavily reliant on hormonal manipulation and advanced targeted therapies. Pharmacists are essential for managing the complex pharmacotherapy of this disease, a topic covered in depth in the Patient Care 5 and Patient Care 2 curricula. This quiz will test your knowledge on Androgen Deprivation Therapy (ADT), novel hormonal agents, and other treatments used in the management of localized and metastatic prostate cancer.
1. The primary goal of Androgen Deprivation Therapy (ADT) in treating prostate cancer is to:
- a. Increase the patient’s testosterone levels.
- b. Reduce serum testosterone to castrate levels.
- c. Cure localized prostate cancer as a monotherapy.
- d. Prevent benign prostatic hyperplasia (BPH).
Answer: b. Reduce serum testosterone to castrate levels.
2. Leuprolide and goserelin are examples of which class of medications used for ADT?
- a. GnRH antagonists
- b. GnRH agonists
- c. 5-alpha reductase inhibitors
- d. First-generation anti-androgens
Answer: b. GnRH agonists
3. What is the initial effect of starting therapy with a GnRH agonist like leuprolide?
- a. An immediate drop in testosterone levels.
- b. A transient surge in LH, FSH, and testosterone, which can cause a “tumor flare.”
- c. An increase in bone mineral density.
- d. A rapid decrease in PSA.
Answer: b. A transient surge in LH, FSH, and testosterone, which can cause a “tumor flare.”
4. To prevent a tumor flare, a GnRH agonist is typically co-administered for the first few weeks with a(n):
- a. Estrogen
- b. 5-alpha reductase inhibitor
- c. Anti-androgen (e.g., bicalutamide)
- d. Corticosteroid
Answer: c. An anti-androgen (e.g., bicalutamide)
5. Degarelix is a GnRH antagonist. How does its mechanism differ from a GnRH agonist?
- a. It causes an initial testosterone surge.
- b. It directly blocks the GnRH receptor in the pituitary, causing a rapid decrease in testosterone without an initial surge.
- c. It inhibits 5-alpha reductase.
- d. It blocks the androgen receptor in the prostate.
Answer: b. It directly blocks the GnRH receptor in the pituitary, causing a rapid decrease in testosterone without an initial surge.
6. The “Management of Prostate Cancer” is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. Abiraterone acetate is used for metastatic castration-resistant prostate cancer (mCRPC). What is its mechanism of action?
- a. It is a potent androgen receptor antagonist.
- b. It inhibits CYP17A1, an enzyme necessary for androgen synthesis in the testes, adrenal glands, and tumor.
- c. It is a form of chemotherapy.
- d. It is a GnRH agonist.
Answer: b. It inhibits CYP17A1, an enzyme necessary for androgen synthesis in the testes, adrenal glands, and tumor.
8. Why must abiraterone be co-administered with prednisone?
- a. To enhance its anticancer effect.
- b. To prevent a compensatory rise in ACTH and subsequent mineralocorticoid excess.
- c. To treat pain from bone metastases.
- d. To prevent nausea and vomiting.
Answer: b. To prevent a compensatory rise in ACTH and subsequent mineralocorticoid excess.
9. Enzalutamide and apalutamide are examples of:
- a. First-generation anti-androgens
- b. GnRH agonists
- c. Second-generation, potent androgen receptor inhibitors
- d. Chemotherapy agents
Answer: c. Second-generation, potent androgen receptor inhibitors
10. A common and expected side effect of any form of Androgen Deprivation Therapy is:
- a. Increased libido
- b. Hot flashes and loss of bone density
- c. Increased muscle mass
- d. Priapism
Answer: b. Hot flashes and loss of bone density
11. The management of urological disorders is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. Which chemotherapy agent is a standard first-line option for patients with metastatic castration-resistant prostate cancer (mCRPC)?
- a. 5-Fluorouracil
- b. Cisplatin
- c. Doxorubicin
- d. Docetaxel
Answer: d. Docetaxel
13. A patient with prostate cancer and known bone metastases may be treated with which of the following to prevent skeletal-related events?
- a. An IV bisphosphonate (e.g., zoledronic acid) or denosumab.
- b. A non-selective beta-blocker.
- c. High-dose calcium supplements alone.
- d. An oral antibiotic.
Answer: a. An IV bisphosphonate (e.g., zoledronic acid) or denosumab.
14. A patient with mCRPC has a germline BRCA2 mutation. They may be a candidate for which class of targeted therapy?
- a. A CDK 4/6 inhibitor
- b. An anti-HER2 agent
- c. A PARP inhibitor
- d. An mTOR inhibitor
Answer: c. A PARP inhibitor
15. Counseling patients on the appropriate use of complex oncology medications is a key role for a pharmacist.
- a. True
- b. False
Answer: a. True
16. What does “castration-resistant prostate cancer” (CRPC) mean?
- a. The patient has had a surgical castration.
- b. The cancer is resistant to all forms of treatment.
- c. The cancer is progressing despite serum testosterone being at castrate levels.
- d. The patient is no longer responding to chemotherapy.
Answer: c. The cancer is progressing despite serum testosterone being at castrate levels.
17. The “Hormonal Agents” lecture in the oncology module of Patient Care 2 would cover ADT.
- a. True
- b. False
Answer: a. True
18. Bicalutamide is a first-generation anti-androgen that works by:
- a. Inhibiting testosterone synthesis.
- b. Blocking the androgen receptor.
- c. Inhibiting 5-alpha reductase.
- d. Blocking GnRH receptors.
Answer: b. Blocking the androgen receptor.
19. Which of the following is NOT a goal of therapy for metastatic prostate cancer?
- a. To prolong survival.
- b. To manage symptoms.
- c. To improve quality of life.
- d. To cure the disease.
Answer: d. To cure the disease.
20. An active learning session on urological disorders is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A patient on abiraterone should be monitored for:
- a. Hypertension, hypokalemia, and fluid retention.
- b. Neutropenia.
- c. Severe diarrhea.
- d. An acneiform rash.
Answer: a. Hypertension, hypokalemia, and fluid retention.
22. “Active surveillance” is an appropriate management strategy for:
- a. All patients with newly diagnosed prostate cancer.
- b. Patients with low-risk, localized prostate cancer.
- c. Patients with metastatic disease.
- d. Patients with castration-resistant disease.
Answer: b. Patients with low-risk, localized prostate cancer.
23. The “Introduction to Urological Disorders” lecture is part of the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
24. An active learning session on men’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A pharmacist’s role in the management of prostate cancer includes all of the following EXCEPT:
- a. Managing side effects of ADT.
- b. Counseling on administration of injectable medications.
- c. Performing a digital rectal exam for screening.
- d. Verifying chemotherapy regimens and doses.
Answer: c. Performing a digital rectal exam for screening.
26. The Gleason score is used to:
- a. Stage the cancer based on its spread.
- b. Grade the aggressiveness of the cancer based on its microscopic appearance.
- c. Measure the patient’s PSA level.
- d. Determine if a patient needs ADT.
Answer: b. Grade the aggressiveness of the cancer based on its microscopic appearance.
27. Radium-223 is a radiopharmaceutical that is used to treat:
- a. Localized prostate cancer.
- b. All forms of metastatic prostate cancer.
- c. Metastatic castration-resistant prostate cancer with symptomatic bone metastases.
- d. The side effects of chemotherapy.
Answer: c. Metastatic castration-resistant prostate cancer with symptomatic bone metastases.
28. An active learning session on urological disorders is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 3: Women’s Health
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
29. The main advantage of using a GnRH antagonist over a GnRH agonist is:
- a. It is an oral medication.
- b. It does not cause a tumor flare.
- c. It is less expensive.
- d. It does not lower testosterone levels.
Answer: b. It does not cause a tumor flare.
30. The management of men’s health is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. A patient on long-term ADT is at an increased risk for:
- a. Osteoporosis and fractures.
- b. Metabolic syndrome.
- c. Cardiovascular disease.
- d. All of the above.
Answer: d. All of the above.
32. A patient taking abiraterone should be counseled to take the medication:
- a. With a high-fat meal to increase absorption.
- b. On an empty stomach.
- c. With a low-fat meal.
- d. At bedtime only.
Answer: b. On an empty stomach.
33. The principles of oncology pharmacotherapy are covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
34. Which of the following is NOT a side effect of docetaxel chemotherapy?
- a. Myelosuppression
- b. Alopecia
- c. Peripheral neuropathy
- d. Increased libido
Answer: d. Increased libido
35. A pharmacist counseling a patient starting on a GnRH agonist depot injection (e.g., Lupron Depot) should inform them that:
- a. It is a one-time injection.
- b. They will need to return for repeat injections every 1, 3, 4, or 6 months depending on the formulation.
- c. It can be self-administered at home.
- d. It will increase their testosterone levels long-term.
Answer: b. They will need to return for repeat injections every 1, 3, 4, or 6 months depending on the formulation.
36. The use of Prostate-Specific Antigen (PSA) for screening is controversial because:
- a. It is not specific for cancer and can be elevated in conditions like BPH or prostatitis.
- b. It can lead to overdiagnosis and overtreatment of low-risk cancers.
- c. Both a and b.
- d. It is not a controversial topic.
Answer: c. Both a and b.
37. Which second-generation anti-androgen is associated with a higher risk of seizures?
- a. Apalutamide
- b. Darolutamide
- c. Bicalutamide
- d. Enzalutamide
Answer: d. Enzalutamide
38. The lecture “Management of Prostate Cancer” is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
39. A patient is being treated with the anti-androgen bicalutamide. This medication works by:
- a. Preventing testosterone synthesis.
- b. Preventing the conversion of testosterone to DHT.
- c. Blocking the androgen receptor.
- d. Blocking the GnRH receptor.
Answer: c. Blocking the androgen receptor.
40. An active learning session covering urological disorders is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. The goal of ADT is to lower testosterone to what level?
- a. < 200 ng/dL
- b. < 150 ng/dL
- c. < 100 ng/dL
- d. < 50 ng/dL
Answer: d. < 50 ng/dL
42. Which of the following is a long-term consequence of ADT?
- a. Decreased risk of diabetes
- b. Increased muscle mass
- c. Increased risk of cardiovascular disease
- d. Improved sexual function
Answer: c. Increased risk of cardiovascular disease
43. The pharmacist’s role in managing prostate cancer therapy is crucial for:
- a. Managing complex side effect profiles.
- b. Ensuring appropriate use of hormonal agents.
- c. Counseling on adherence.
- d. All of the above.
Answer: d. All of the above.
44. A patient on ADT complains of severe hot flashes. A potential treatment for this side effect is:
- a. A low dose of an antidepressant like venlafaxine.
- b. Testosterone replacement.
- c. An NSAID.
- d. A diuretic.
Answer: a. A low dose of an antidepressant like venlafaxine.
45. What is the role of a pharmacist in active surveillance for prostate cancer?
- a. To ensure the patient is not on any medications that could falsely alter PSA levels.
- b. To perform the surveillance biopsies.
- c. To prescribe chemotherapy.
- d. There is no role for a pharmacist.
Answer: a. To ensure the patient is not on any medications that could falsely alter PSA levels.
46. “Hormonal Agents” are discussed as part of the anticancer therapeutics lectures in Patient Care 2.
- a. True
- b. False
Answer: a. True
47. A patient with mCRPC is starting chemotherapy with docetaxel. The pharmacist should ensure they are also prescribed what supportive care medication to reduce fluid retention and hypersensitivity reactions?
- a. A corticosteroid like dexamethasone.
- b. An antihistamine.
- c. An antiemetic.
- d. A G-CSF like filgrastim.
Answer: a. A corticosteroid like dexamethasone.
48. An active learning session on men’s health is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
49. The overall management of advanced prostate cancer often involves:
- a. A single line of therapy.
- b. Sequencing multiple lines of therapy (e.g., ADT, novel hormonal agents, chemotherapy) as the disease progresses.
- c. Only supportive care.
- d. A “one-size-fits-all” approach.
Answer: b. Sequencing multiple lines of therapy (e.g., ADT, novel hormonal agents, chemotherapy) as the disease progresses.
50. The ultimate goal of learning about the management of prostate cancer is to:
- a. Be able to recommend safe and effective, evidence-based pharmacotherapy to improve patient survival and quality of life.
- b. Memorize all the chemotherapy regimens.
- c. Pass the final exam.
- d. Become an expert in interpreting PSA results.
Answer: a. Be able to recommend safe and effective, evidence-based pharmacotherapy to improve patient survival and quality of life.