A 71-year-old man diagnosed with a stage T2 prostate tumor 2 years ago has elected watchful waiting, based upon an underlying heart condition that renders surgery potentially fatal
Recently, his PSA has jumped considerably, as have his levels of serum acid phosphatase. Which course of action would be least appropriate at this stage?
A)
Combination treatment with an antiandrogen and a GnRH agonist
B)
Treatment with bisphosphonates
C)
Treatment with GnRH agonists alone
D)
Treatment with ketoconazole
Ans:
C
Feedback:
The sharp rise in PSA, coupled with an increase in levels of serum acid phosphatase, is strongly indicative of metastatic cancer (which could be confirmed via molecular imaging such as MRI). Unopposed GnRH agonists initially cause LH and FSH levels to rise, stimulating the production of testosterone, which acts as fuel for the fire of prostatic metastasis. Thus, their use alone would not be appropriate. However, if these agonists are combined with antiandrogens, testosterone levels can be quelled from two different fronts simultaneously. Ketoconazole is a chemical castrating agent that could bring down testosterone levels rapidly and might be more appropriate for cases of advanced and widespread metastasis. Bisphosphonates address the effects of metastatic bone involvement and of osteoporosis resulting from antiandrogen therapy.
You might also like to view...
While orienting to the critical care unit, the newly hired nurse notices that the preceptor is using a tablet computer during medication administration. The new nurse says, "That looks awkward and time consuming." How should the preceptor reply?
1. "It is awkward but it is required and I am getting accustomed to it." 2. "I use it to make certain I am medicating the right patient." 3. "Using a tablet computer actually increases the speed at which I can deliver care." 4. "I use the tablet computer to check on dosing and side effect information when I am giving new medications."
A school-age child with a rash over the abdomen now has a bright red tongue. The health care provider is going to begin treatment for scarlet fever. On which medication should the nurse instruct the mother for the child's care?
A) Aspirin B) Steroids C) Antibiotics D) Antifungal medication
A comprehensive assessment is usually done
a. upon admission to a health care facility b. upon discharge from a health care facility c. to focus in-depth on a particular health care problem d. to provide systematic monitoring and observation related to specific problems
Describe the major changes that take place in the nervous system with aging.
What will be an ideal response?