CUA 2020- metastatic Castration sensitive and naïve prostate cancer Flashcards
Which patients with prostate cancer should have staging investigations?
anyone with high risk features. PSA>20, GS>7, clinical stage T3 or greater.
CT and bone scan
What is high volume disease based on CHAARTED defenition?
> /=4 bone mets with at least one being outside of vertebral bodies or pelvis or presence of visceral metastasis
What was latitude definition of high risk?
Visceral mets, >/=3 bony mets. or GS>/=8. high risk would be at least two of these criteria
What are some other predictors of worse prognosis?
appendicular disease (defined as bone lesions in
the chest, skull, and/or extremities), worse performance status,
PSA >65, Gleason score ≥8, high alkaline phosphatase
(ALP), high pain intensity, anemia, and elevated lactate
dehydrogenase (LDH).
what did HORRAD study show?
no difference in OS but time to PSA progression was improved. average PSA 140, 67% of patients had more than 5 bone mets.
What were the findings of STAMPEDE RT for metastatic prostate cancer study?
FFS improved in both high and low metastatic burden,
OS only improved in low metastatic burden. Same criteriae as CHAARTED
what are treatment options in addition of ADT for metastatic hormone naive people?
High risk or high volume Docetaxel
low volume but good performance status docetaxel is an option(not sure why they put this in GL, no one does this)
Abi can be considered in patients with low volume disease
Abi + prednisone for high risk patients
Enzalutamide and apalutamide are options regardless of volume/risk
Should you give Enza with Docetaxel?
NO,
But can give it after Docetaxel
How does Enzalutamide work?
It is AR receptor antagonist that binds to it and prevents AR nuclear translocation and interaction with DNA.
What are the two studies that looked at role of Enza in mCSPC
ENZEMAT - ADT + NSAA vs ADT+ENZA -OS survival seen with Enza ARCHES -- primary endpoint was radiological PFS - benefit was seen in both chemo treated and not chemo treated group
How does Apalutamide work?
Prevents AR nuclear translocation and DNA binding
What were the studies for Apalutamide in this space?
TITAN APA+ADT vs ADT improved rPFS improved OS benefit regardless of disease burden
What are recommendations regarding prevention of risk of osteoprosis?
All men should get Vitd and calcium , smoking cessation, reduction in alcohol and caffeine intake, increased in weight bearing exercises.
men starting ADT should have bone mineral density scan or DXA scan. Risk calculators such as FRAX should be used. DXA Q 2 years. those with high risk of fractures should get Zolerodnic acid, Alendronate, denosumab
What T scores would be osteopenia on DXA scan? what is Osteoprosis?
osteopenia(-1 to -2.5)
Osteoporosis: less than -2.5
The above groups are the ones you want on bone targeted therapy
