Exam 2 - Prostate Cancer Flashcards
Most common histology type of prostate cancer
adenocarcinoma
Most common site of metastases in prostate cancer
Bone
Treatment options for localized disease:
- active surveillance
- radiation
- surgery
(may add ADT if high risk)
LHRH agonists acute toxicities
tumor flare (metastatic setting), gynecomastia, hot flashes, erectile dysfunction, edema, injection site reactions
LHRH agonists long-term toxicities
(similar to estrogen deprivation symptoms)
osteoporosis, fractures, obesity, insulin resistance, increased risk of both diabetes and CV events
Anti-androgens toxicities
diarrhea, hematuria
Which anti-androgen is the drug of choice and why?
Bicalutamide (Casodex) - long half-life and daily dosing
What is the goal level of testosterone after 1 month of using ADT?
< 50 ng/dL
Caution using enzalutamide in patients with history of….
Seizures
Patients need to take prednisone with which anti-androgen drug?
Abiraterone
Which androgen receptor antagonist offers potentially less toxicities than others?
Darolutamide
For men who at not high-risk, what age should they start prostate cancer screening?
50
If a man’s PSA ≥ 2.5 ng/mL, how often should they get screened?
annually
If a man’s PSA < 2.5 ng/mL, how often should they get screened?
every 2 years
What is an important factor in determining what treatment plan the patient receives with m1 disease?
low volume vs high volume
Treatment options for m0HSPC:
- observation
- ADT
Treatment options for m0CRPC:
ADT +
Enzalutamide
Apalutamide
Darolutamide
Treatment options for m1HSPC low volume:
ADT
ADT + abiraterone
ADT + enzalutamide
ADT + apalutamide
Sipuleucel T
Treatment options for m1HSPC (high volume):
ADT
ADT + abiraterone
ADT + enzalutamide
ADT + docetaxel + abiraterone
ADT + docetaxel + darolutamide
Treatment options for m1CRPC:
-Genomic testing, dMMR, MSI status
-Continue ADT +
1. Sipuleucel-T
2. Docetaxel
3. Cabazitaxel
4. Radium 223
5. Abiraterone
6. Enzalutamide
A patient is receiving ADT with darolutamide, but his PSA is increasing and his scans show bony metastases. If he wants to avoid significant toxicities, what would be the best treatment option?
What would be used to treat his bony metastases?
Abiraterone + prednisone
Zoledronic acid
Patient presents with high volume disease (diffuse bone and liver metastases). What would be the appropriate treatment for this patient?
ADT + docetaxel + abiraterone/darolutamide
