Exam 2 - Prostate Cancer Flashcards
List risk factors for prostate cancer?
African American (less common in Asians), older age, family history
What is the median age at diagnosis for prostate cancer?
67
What are harms from screening for prostate cancer?
urinary complications, erectile dysfunction, infections
List signs/symptoms of prostate cancer?
asymptomatic if localized, ureteral dysfunction, urinary frequency/hesitancy/incomplete emptying, flank pain, lower-extremity edema, anemia, pathologic fractures
What is considered a low Gleason score? High?
low = 6 or less; high = 8+
What is treatment for all types of localized recurrence risks for prostate cancer?
observation, active surveillance, external beam radiation therapy (EBRT), or radical prostatectomy (RP)
What is treatment for regional recurrence risks for prostate cancer?
observation, active surveillance, external beam radiation therapy (EBRT), androgen deprivation therapy (ADT), abiraterone, radical prostatectomy (RP), or pelvic lymph node dissection (PLND)
What is treatment for castrate naïve (sensitive) advanced prostate cancer?
non-metastatic = monitoring or androgen deprivation therapy (ADT), metastatic = androgen deprivation therapy (ADT) plus abiraterone or enzalutamide or apalutamide or darolutamide or docetaxel x6 cycles
What is treatment for castrate resistant advanced prostate cancer?
recurrent = androgen deprivation therapy (ADT) plus PSADT, metastatic = ADT plus abiraterone, doxetaxel x6 cycles, enzalutamide, sipuleucel-T, radium 223, other hormonal therapy (adenocarcinoma) or chemotherapy options with best supportive care (small cell or neuroendocrine)
What is considered the gold standard for prostate cancer therapy?
androgen deprivation therapy (ADT)
What is the goal testosterone level and when while on an LHRH agonist?
<50 ng/dL by one month
List the LHRH agonists? (4)
goserelin (Zoladex), leuprolide (Lupron IM, Eligard SQ), triptorelin (Trelstar), histrelin (Vantas)
What are acute AEs of LHRH agonists?
tumor flare (increased testosterone), hot flashes, ED, edema, gynecomastia, injection site reactions
What are long-term AEs of LHRH agonists?
osteoporosis (calcium and Vitamin D supplementation), obesity, insulin resistance (diabetes), CV events, hyperlipidemia
List the LHRH antagonists? (2)
degarelix (Firmagon), relugolix (Orgovyx)
List disadvantages to LNRH antagonists? (2)
less flexibility in dosing, high cost
List the first-generation antiandrogens?
bicalutamide (Casodex), flutamide (Eulexin), nilutamide (Nilandron)
List the second-generation antiandrogens?
apalutamide, enzalutamide, darolutamide
What are AEs of antiadrogens?
diarrhea, gynecomastia, elevated LFTs, hot flashes
Explain the consensus regarding combined androgen blockades for prostate cancer treatment?
associated with more ADEs and provide modest to no benefit over castration alone
What is recommendation for PSA doubling time >10 months?
monitor OR other secondary hormone therapy
What is recommendation for PSA doubling time </=10 months?
apalutamide, enzalutamide, darolutamide, other secondary hormone therapy
List examples of other secondary hormone therapies for prostate cancer? (4)
first generation antiandrogens (nilutamide, flutamide, bicalutamide), corticosteroids, antiandrogen withdrawal, ketoconazole plus hydrocortisone
What is the MOA of apalutamide (Erleada)?
nonsteroidal androgen receptor (AR) inhibitor; binds directly to the AR ligand-binding domain to prevent androgen-receptor translocation, DNA binding, and receptor-mediated transcription
What are AEs of apalutamide (Erleada)?
fatigue, HTN, rash, GI, arthralgias, fractures, edema
What is a side effect unique to apalutamide (Erleada) and enzalutamide (Xtandi)?
seizures
What is the MOA of darolutamide (Nubeqa)?
competitive androgen receptor (AR) inhibitor
What are AEs of darolutamide (Nubeqa)?
fatigue, HTN, rash
What is the MOA of enzalutamide (Xtandi)?
pure androgen receptor (AR) signaling inhibitor
What are AEs of enzalutamide (Xtandi)?
diarrhea, fatigue, HA, myalgias, edema
What are preferred regimens for metastatic CRPC with no prior therapies? (3)
abiraterone, docetaxel, enzalutamide
What are preferred regimens for metastatic CRPC with prior novel hormone therapy/no prior docetaxel? (2)
docetaxel, olaparib or rucaparib
What are preferred regimens for metastatic CRPC with prior docetaxel/no prior novel hormone therapy? (3)
abiraterone, cabazitaxel, enzalutamide
What are preferred regimens for metastatic CRPC with prior docetaxel and novel hormone therapy? (2)
cabazitaxel, docetaxel rechallenge
What is recommended treatment for symptomatic bone metastases from CRPC?
radium 223
What is the MOA of docetaxel (Taxotere)?
promotes assembly of microtubules and inhibits depolymerization of tubulin
What are AEs of docetaxel (Taxotere)?
myelosuppression, alopecia, edema, peripheral neuropathy, hypersensitivity, CAUTION IN LIVER IMPAIRMENT
What is the MOA of abiraterone (Zytiga, Yonsa)?
selectively and irreversibly inhibits CYP17, an enzyme required for androgen biosynthesis
What are AEs of abiraterone (Zytiga, Yonsa)?
diarrhea, edema, hypokalemia, HTN, hepatotoxicity, hypertriglyceridemia
What is the MOA of olaparib (Lynparza)?
selectively inhibits poly (ADP-ribose) polymerase (PARP) enzymes, which aid in DNA repair
What are AEs of olaparib (Lynparza)?
GI, neutropenia, leukopenia, URTIs, double cancer risk
What is the MOA of radium-223 (Xofigo)?
alpha-emitter that causes ds breaks
What are AEs of radium-223 (Xofigo)?
nausea, myelosuppression, edema
What is the MOA of sipuleucel-T (Provenge)?
dendritic cell vaccine designed to enhance immune T-cell response (CAR-T therapy)
What are AEs of sipuleucel-T (Provenge)?
infusion related reactions, fever-like symptoms, HA
What is the MOA of cabazitaxel (Jevtana)?
promotes assembly of microtubules and inhibits depolymerization of tubulin
What are AEs of cabazitaxel (Jevtana)?
febrile neutropenia, hypersensitivity reactions, mucositis, edema
What is the MOA of lutetium-177 (Pluvicto)?
beta-emitter that selectively binds to PSMA receptors on prostate cancer cells
What are AEs of lutetium-177 (Pluvicto)?
fatigue, dry mouth, nausea, myelosuppression
What is treatment for ADT-induced bone loss in prostate cancer? Osteoporosis?
denosumab (Prolia), zoledronic acid (Reclast)
