B8-048 CBCL Prostate Cancer Flashcards
what is the normal function of PSA?
reproductive protein that nourishes sperm
based on USPTF, men in what age range should be screened for prostate cancer?
55-69
major risk factors for prostate cancer [4]
african american
increasing age
family hx of prostate cancer
BRCA2 or Lynch syndromes
(Two or more family members with hx confers highest risk, brother with hx is next highest and confers greater risk than father)
what BRCA gene increases the risk of prostate cancer?
BRCA2
[…]% of men with a palpable finding on DRE have prostate cancer
40
from what zone of the prostate does cancer develop?
peripheral
if a man has a concerning PSA, why is MRI done prior to biopsy?
identifies lesions
able to rule out prostate cancer
provides anatomic assessment
the USPTF currently [does/does not] recommend screening
recommends selective screening
evidence of some benefit
how many men must be screened to prevent 1 death from prostate cancer?
1000
what is the approximate lifetime risk of prostate cancer?
1 in 10
what is the approximate lifetime risk of dying from prostate cancer?
1 in 40
what is the most common symptom of prostate cancer?
commonly asymptomatic
what is the most potent hormone for AR stimulation?
DHT
what is the value of DRE in men with prostate cancer?
tells you how to stage the cancer
what percentage of men on active surveillance will require treatment in 5 years?
25 to 50%
what percentage of men experience long-term incontinence after radical prostatectomy?
2-5%
(pelvic floor therapy)
adverse effect of bicaltumide
breast tenderness
what is the definition of castration resistant prostate cancer?
PSA continue to rise despite T being below castration level (50)
MOA: microtubule inhibition
docetaxel
MOA: 17-hydroxylase inhibitor
abiratone acetate
what genetic syndromes are risk factors for prostate cancer? [2]
Lynch
BRCA2
what causes PSA to leak into blood steam?
loss of basal cell layer
(could be caused by many things)
african-american men are more likely to have cancer affecting the […] lobe of the prostate
anterior
(could be part of risk, not felt on DRE)
if the DRE is abnormal, the next best step is […]
biopsy
(no need for MRI first)
if the PSA is elevated, next best step is […]
MRI
(then biopsy if MRI doesn’t rule it out)
the first number of the Gleason score is the […] cancer
predominant
in the Gleason score
1-2 are […]
3-5 are […]
in the Gleason score
1-2 are [normal]
3-5 are [cancerous]
Gleason 3+3 would be grade […]
1
Gleason 3+4 would be grade […]
2
Gleason 4+3 would be grade […]
3
Gleason 8 would be grade […]
4
Gleason 9-10 would be grade […]
5
clinical staging of prostate cancer is based on
DRE
(if you can feel it, higher stage)
what Gleason grade groups should be sent for bone and soft tissue imaging?
4 and 5
radiation and surgery are considered options with […] intent
curative
(indicated in localized or locally advanced disease)
the goal of androgen therapy and chemotherapy is […]
control
(no longer curative intent)
what percentage of men experience long-term erectile dysfunction after radical prostatectomy?
20-25%
(PDE5i)
implantation of permanent radioactive seed that deliver radiation over time
brachytherapy
radiation options [3]
external beam
stereotactic
brachytherapy
Gleason Grade group 3 should receive […] months of ADT
6
Gleason Grade group 4-5 should receive […] months of ADT
18-3 years
MOA: LHRH antagonist
degarelix
MOA: LHRH agonist
leuprolide
MOA: competitive inhibitor of AR
bicalutamide
(can be used at initiation of leuprolide therapy to block initial T surge)
MOA:
prevents T binding to AR
prevents translocation of AR to nucleus
prevents binding of AR to DNA
ARTA
enzalutamide/apalutamide/darolutamide
MOA: anti-PDL1 agent
pembrolizumab
MOA: DNA repair enzyme inhibition
PARP inhibition
(indicated for BRCA1/2, MSH/MLH, ATM, etc)
MOA: accumulates in bone regions were bone turnover is occuring
radium-223
(indicated in symptomatic bone mets)
what activity can falsely elevate PSA?
bicycling
treatment of hypertension and hypokalemia due to abiraterone acetate
steroids
The USPTF recommended shared decision making in patients aged […]
55-69
some evidence of benefit
MRI of the prostate is effective in detecting around […] of clinically significant prostate cancers
90%
BRCA1/2 carriers are at a […] fold increased risk of incident prostate cancer.
5-8
In the US based screening trial – on which initial USPTF recommendations were made – the rate of contamination (by PSA screening) in the control arm was around […]%
90%
it would take […] men diagnosed with prostate cancer in order to avert 1 death from disease.
12
Low risk disease is classified as grade group […] disease with a PSA […] and no palpable lesions
Low risk disease is classified as grade group [1] disease with a PSA [less than 10] and no palpable lesions
Approximately […]% of patients are found to have higher grade prostate cancer at the time of surgical resection.
40
major advantage of surgery over radiation
allows for a pathologic assessment of the entire gland
Surgery has the advantage of being able to salvage recurrences with […]
radiation
[…] can cause irritative urinary and bowel symptoms (urgency).
radiation
The definition of recurrence is a post-nadir (lowest) PSA that is […]ng/ml higher than the nadir.
2
side effects of ADT [5]
hot flashes
fatigue
decreased bone mass
decreased muscle mass
decreased libido
(also increases risk for CVD and metabolic disease)
the levels of estrogen in men are directly tied to the amount circulate […]
T
The average time from initiation of androgen deprivation therapy to castration resistance is […] years.
8-10
the average time from castration resistance to death from disease is […] years
2-6
signs of hyperaldosteronism
hypertension
volume expansion
hypokalemia
What is the hormone that is responsible for the need to pair abiraterone with prednisone?
ACTH
