Genitourinary: prostate carcinoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Pathology · Genitourinary: prostate carcinoma

Sample item

A 68-year-old man has a raised PSA and a hard nodule palpable on rectal examination. Biopsy shows crowded small glands lacking basal cells, with Gleason pattern 4 as the commonest pattern and pattern 3 as the second most common. What is the Gleason score, and where does most of this cancer arise?

A6 (3+3), in the central zoneB8 (4+4), in the transition zoneC7 (3+4), in the transition zoneD7 (4+3), in the peripheral zone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. 7 (4+3), in the peripheral zone

The Gleason score is the sum of the most common and second most common patterns, written primary plus secondary, so 4+3 equals 7. Most prostate adenocarcinomas arise in the peripheral zone, which is why they are palpable on rectal examination. Benign prostatic hyperplasia arises in the transition zone.

Option by option

A. 6 (3+3), in the central zone
The sum of 4 and 3 is not 6 and the central zone is not the usual site.
B. 8 (4+4), in the transition zone
The sum is 7, not 8, and the tumour does not usually arise in the transition zone.
C. 7 (3+4), in the transition zone
The order is 4+3 here, not 3+4, and the transition zone is the usual site of BPH.
D. 7 (4+3), in the peripheral zone (correct)
Correct. Pattern 4 plus pattern 3 gives 7, and the peripheral zone is the usual site.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, 7 (4+3), in the peripheral zone. The Gleason score is the sum of the most common and second most common patterns, written primary plus secondary, so 4+3 equals 7.

Why is "6 (3+3), in the central zone" not the answer?

The sum of 4 and 3 is not 6 and the central zone is not the usual site.

Why is "8 (4+4), in the transition zone" not the answer?

The sum is 7, not 8, and the tumour does not usually arise in the transition zone.

Why is "7 (3+4), in the transition zone" not the answer?

The order is 4+3 here, not 3+4, and the transition zone is the usual site of BPH.

What concept does this question test?

It tests Genitourinary: prostate carcinoma in Pathology. Most prostate adenocarcinomas arise in the peripheral zone, which is why they are palpable on rectal examination. Benign prostatic hyperplasia arises in the transition zone.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Genitourinary: prostate carcinoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.