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PHM703 Heme/Onc/Crit Care > Exam 2 - Prostate Cancer > Flashcards

Exam 2 - Prostate Cancer Flashcards

1
Q

List risk factors for prostate cancer?

A

African American (less common in Asians), older age, family history

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2
Q

What is the median age at diagnosis for prostate cancer?

A

67

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3
Q

What are harms from screening for prostate cancer?

A

urinary complications, erectile dysfunction, infections

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4
Q

List signs/symptoms of prostate cancer?

A

asymptomatic if localized, ureteral dysfunction, urinary frequency/hesitancy/incomplete emptying, flank pain, lower-extremity edema, anemia, pathologic fractures

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5
Q

What is considered a low Gleason score? High?

A

low = 6 or less; high = 8+

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6
Q

What is treatment for all types of localized recurrence risks for prostate cancer?

A

observation, active surveillance, external beam radiation therapy (EBRT), or radical prostatectomy (RP)

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7
Q

What is treatment for regional recurrence risks for prostate cancer?

A

observation, active surveillance, external beam radiation therapy (EBRT), androgen deprivation therapy (ADT), abiraterone, radical prostatectomy (RP), or pelvic lymph node dissection (PLND)

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8
Q

What is treatment for castrate naïve (sensitive) advanced prostate cancer?

A

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

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9
Q

What is treatment for castrate resistant advanced prostate cancer?

A

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)

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10
Q

What is considered the gold standard for prostate cancer therapy?

A

androgen deprivation therapy (ADT)

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11
Q

What is the goal testosterone level and when while on an LHRH agonist?

A

<50 ng/dL by one month

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12
Q

List the LHRH agonists? (4)

A

goserelin (Zoladex), leuprolide (Lupron IM, Eligard SQ), triptorelin (Trelstar), histrelin (Vantas)

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13
Q

What are acute AEs of LHRH agonists?

A

tumor flare (increased testosterone), hot flashes, ED, edema, gynecomastia, injection site reactions

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14
Q

What are long-term AEs of LHRH agonists?

A

osteoporosis (calcium and Vitamin D supplementation), obesity, insulin resistance (diabetes), CV events, hyperlipidemia

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15
Q

List the LHRH antagonists? (2)

A

degarelix (Firmagon), relugolix (Orgovyx)

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16
Q

List disadvantages to LNRH antagonists? (2)

A

less flexibility in dosing, high cost

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17
Q

List the first-generation antiandrogens?

A

bicalutamide (Casodex), flutamide (Eulexin), nilutamide (Nilandron)

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18
Q

List the second-generation antiandrogens?

A

apalutamide, enzalutamide, darolutamide

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19
Q

What are AEs of antiadrogens?

A

diarrhea, gynecomastia, elevated LFTs, hot flashes

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20
Q

Explain the consensus regarding combined androgen blockades for prostate cancer treatment?

A

associated with more ADEs and provide modest to no benefit over castration alone

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21
Q

What is recommendation for PSA doubling time >10 months?

A

monitor OR other secondary hormone therapy

22
Q

What is recommendation for PSA doubling time </=10 months?

A

apalutamide, enzalutamide, darolutamide, other secondary hormone therapy

23
Q

List examples of other secondary hormone therapies for prostate cancer? (4)

A

first generation antiandrogens (nilutamide, flutamide, bicalutamide), corticosteroids, antiandrogen withdrawal, ketoconazole plus hydrocortisone

24
Q

What is the MOA of apalutamide (Erleada)?

A

nonsteroidal androgen receptor (AR) inhibitor; binds directly to the AR ligand-binding domain to prevent androgen-receptor translocation, DNA binding, and receptor-mediated transcription

25
Q

What are AEs of apalutamide (Erleada)?

A

fatigue, HTN, rash, GI, arthralgias, fractures, edema

26
Q

What is a side effect unique to apalutamide (Erleada) and enzalutamide (Xtandi)?

A

seizures

27
Q

What is the MOA of darolutamide (Nubeqa)?

A

competitive androgen receptor (AR) inhibitor

28
Q

What are AEs of darolutamide (Nubeqa)?

A

fatigue, HTN, rash

29
Q

What is the MOA of enzalutamide (Xtandi)?

A

pure androgen receptor (AR) signaling inhibitor

30
Q

What are AEs of enzalutamide (Xtandi)?

A

diarrhea, fatigue, HA, myalgias, edema

31
Q

What are preferred regimens for metastatic CRPC with no prior therapies? (3)

A

abiraterone, docetaxel, enzalutamide

32
Q

What are preferred regimens for metastatic CRPC with prior novel hormone therapy/no prior docetaxel? (2)

A

docetaxel, olaparib or rucaparib

33
Q

What are preferred regimens for metastatic CRPC with prior docetaxel/no prior novel hormone therapy? (3)

A

abiraterone, cabazitaxel, enzalutamide

34
Q

What are preferred regimens for metastatic CRPC with prior docetaxel and novel hormone therapy? (2)

A

cabazitaxel, docetaxel rechallenge

35
Q

What is recommended treatment for symptomatic bone metastases from CRPC?

A

radium 223

36
Q

What is the MOA of docetaxel (Taxotere)?

A

promotes assembly of microtubules and inhibits depolymerization of tubulin

37
Q

What are AEs of docetaxel (Taxotere)?

A

myelosuppression, alopecia, edema, peripheral neuropathy, hypersensitivity, CAUTION IN LIVER IMPAIRMENT

38
Q

What is the MOA of abiraterone (Zytiga, Yonsa)?

A

selectively and irreversibly inhibits CYP17, an enzyme required for androgen biosynthesis

39
Q

What are AEs of abiraterone (Zytiga, Yonsa)?

A

diarrhea, edema, hypokalemia, HTN, hepatotoxicity, hypertriglyceridemia

40
Q

What is the MOA of olaparib (Lynparza)?

A

selectively inhibits poly (ADP-ribose) polymerase (PARP) enzymes, which aid in DNA repair

41
Q

What are AEs of olaparib (Lynparza)?

A

GI, neutropenia, leukopenia, URTIs, double cancer risk

42
Q

What is the MOA of radium-223 (Xofigo)?

A

alpha-emitter that causes ds breaks

43
Q

What are AEs of radium-223 (Xofigo)?

A

nausea, myelosuppression, edema

44
Q

What is the MOA of sipuleucel-T (Provenge)?

A

dendritic cell vaccine designed to enhance immune T-cell response (CAR-T therapy)

45
Q

What are AEs of sipuleucel-T (Provenge)?

A

infusion related reactions, fever-like symptoms, HA

46
Q

What is the MOA of cabazitaxel (Jevtana)?

A

promotes assembly of microtubules and inhibits depolymerization of tubulin

47
Q

What are AEs of cabazitaxel (Jevtana)?

A

febrile neutropenia, hypersensitivity reactions, mucositis, edema

48
Q

What is the MOA of lutetium-177 (Pluvicto)?

A

beta-emitter that selectively binds to PSMA receptors on prostate cancer cells

49
Q

What are AEs of lutetium-177 (Pluvicto)?

A

fatigue, dry mouth, nausea, myelosuppression

50
Q

What is treatment for ADT-induced bone loss in prostate cancer? Osteoporosis?

A

denosumab (Prolia), zoledronic acid (Reclast)

PHM703 Heme/Onc/Crit Care (18 decks)

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