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CDM 4 Exam 3 > Lecture 5 - Prostate Cancer > Flashcards

Lecture 5 - Prostate Cancer Flashcards

1
Q

Risk factors for Prostate Cancer

A

2/3 cases men > 65
Serum Test Lvls = higher lvls higher risk
Agricultural exposures
FH
Diet = High red meat n high-fat dairy, low fruit/veggies
Race = AA> W > His > Pacifici > Native American

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2
Q

Signs n Symptoms of Prostate Cancer

A

weak/interrupted stream
Incomplete bladder emptying
Painful/burning urination
Frequent/urgent urination
Difficulty stopping/starting stream
ED

Distant Disease = bone pin = back/legs/hips

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3
Q

Prostate Cancer screening

A

Age 50 = men at average risk n live 10+ yrs
Age 45 = high risk
Age 40 = higher risk, more than 1 1st degree relative who has

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4
Q

Time until future screen based on PSA

A

< 2.5 = every 2 years
> 2.5 = yearly

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5
Q

Prostate screening tools

A

Digital Rectal Exam
PSA, usually > 20 = cancer
PSA velocity = 3 consecutive measurements over 18-24mnth
PSA doubling time = time for PSA to double

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6
Q

Somatic mutations are associated with….

A

gremline mutations
BRCA1/2 mutations associated w/ inc prostate cancer risk
BRCA2 = 2-6X inc risk

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7
Q

Patients with HRR/BRCA mutations may benefit from….

A

PARP inhibitors

Olaparib, Rucaparib

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8
Q

DNA mismatch repair genes may benefit from….

A

PD-1 inhibitor

Pembrolizumab

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9
Q

Who gets gremline genetic testing

A

+ FH of gremlin mutations BRCA1/2, Lynch mutation
High risk, V High risk, regional or metastatic prostate cancer
Ashkenazi Jewish ancestry
Specific FH cancer

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10
Q

Gleason scores

A

< 6 = well differentiated, less aggressive
7 = moderately differentiated
8-10 = poorly differentiated, highly aggressive

if 2 numbers, 1st is more common

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11
Q

Localized disease is generally stages….

A

1 n 2

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12
Q

Regional disease (locally advanced) generally stage…..

A

3

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13
Q

Advanced/metastatic disease generally stage…..

A

4

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14
Q

active surveillance is…

A

active monitoring course of disease with expectation of applying curative therapy if cancer progresses

Usually, younger men with indolent disease
Delay doesnt affect cure rate

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15
Q

Who is recommended for active surveillance….

A

Very low risk disease and life expectancy greater than or equal to 20 yrs

low risk disease and life expectancy at least 10 yrs

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16
Q

Radical Prostatectomy is…

A

removing all that shit

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17
Q

Radical Prostatectomy post-op complications

A

impotence
incontinence
rectal damage
hemorrhage
infection

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18
Q

External Beam Radiation Therapy Pro vs Cons

A

Pro: avoids surgery issues, no anesthesia, low risk of ED, other urinary issues

Con: 8-9 wk txm, inc risk ED over time, risk of renal symptoms

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19
Q

Brachytherapy Pro vs Cons

A

inserting seeds to area

Pro: txm 1 day, ED unlikely short term, low risk incontinence

Con: anesthesia, limited by size of prostate, acute urinary retention, persistence of irritating voiding symptoms

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20
Q

Goal of Androgen Deprivation Therapy

A

Suppress testosterone to < 50ng/dL

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21
Q

GnRH Antagonists info

A

inhibit production of GnRH

Rapid, no risk of tumor flare

Ex. Degarelix, relugolix

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22
Q

GnRH Agonists info

A

Stimulate production of GnRH

Weeks onset, risk of tumor flare = 1st few days

Ex. Leuprolide, goserelin

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23
Q

Bilateral Orchiectomy Pro vs Con

A

Pro: 1 time deal, cost, avoid inj, immediate benefit

Con: Hot flashes, dec libido, impotence, may not tolerate surgery, psychological

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24
Q

Leuprolide inj info

A

LNRH Agonist
Monthly, Q3, Q4 or Q6 month option

Lupron = IM
Eligard = SubQ

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25
Goserelin (Zoladex) info
LNRH Agonist Monthly or Q3 month SubQ only
26
Triptorelin (Trelstar) info
LNRH Agonist Monthly, Q3, Q6 month IM
27
Histrelin (Vantas) info
LNRH Agonist SQ every 12 months
28
LNRH Agonist Pro vs Con
Pro: avoid surgery, infrequent admin, low toxicity, as effective as surgery Con: injection, disease flare, $$$, hot flashes, dec lean body mass n muscle strength, inc fat
29
Androgen flare
symptoms worsen in 2-3 weeks warnings: Severe urethral obstruction, painful vertebral metastases, spinal cord compression, temp inc in bone pain
30
Androgen flare prevention
Concurent anti-androgen Bicalutamide 50mg PO QD for 1st 7 days of therapy
31
Adverse drug reactions of ADTs
Osteoporosis/inc fracture risk Obesity/Diabetes Fatigue Lipid alterations Hot flashes Inc CVD risk
32
Hot flash management
Megestrol 20mg BID Venlafaxine 12.5-25mg BID Paroxetine 12.5-37.5mg QD Gabapentin 600mg QD
33
Flare risk with LNRH Antagonists?
nah not really
34
LNRH Agonist vs Antagonists
Agonist: Q3-6M, disease flare, few local reaction, delayed onset Antagonist: may lower CV risk, Rapid onset, Qmonthly, no flares
35
Flutamide unique side effect?
turns piss gold or yellow-green
36
Nilutamide unique side effect?
Dark adaption difficulties = eyes adjust slower alc interaction
37
Combined Androgen Blockade (CAB) info
More $$$, more ADE No proven benefit over med/surg castration alone not much data
38
Combined ADT with novel agents and/or chemotherapy....
ADT +... 1. Docetaxel = myelosupression, febrile reactions, neuropathy 2. Abiraterone = hypokalemia, HTN, Hepatotoxicity, edema 3. Enzalutamide = fatigue, lower seizure threshold, falls 4. Apalutamide = fatigue, rash, Hypothyroidism, seizure risk, falls combo overall improves survival
39
What to give pts with new diagnosed metastatic CSPC
ADT + 2nd gen (Docetaxel, Abiraterone, Enzalutamide, Apalutamide)
40
Triplet Therapy info
combine 3 drugs but can be very toxic very few can tolerate effects of these therapies, tend to be younger pts
41
Goal of metastatic setting?
palliative intent, not curative
42
Castration-Resistant Prostate Cancer (CRPC)
disease progression during treatment with ADT Test < 50, but cancer progressing management = continue ADT +/- additional agents ADT for life
43
M1 (Metastatic CRPC)
spread to distant site
44
M0 (Non-metastatic CRPC)
only evidence is rising PSA
45
Non-metastatic (M0) CRPC management
PSA doubling time > 10 months = continue ADT + observation PSA dbling time < 10 months = continue ADT + 2ndary hormonal agent
46
2ndary hormonal agents for M0 CRPC
Apalutamide = dec seizure threshold, falls, fractures Darolutamide = less CNS too, renal impairment Enzalutamide = dec seizure threshold, falls, fractures
47
drugs that interfere with androgenic stimulators of tumor growth (for M1)
Enzalutamide Apalutamide Darolutamide
48
drugs that cause inhibition of androgen synthesis (for M1)
Abiraterone
49
Chemodrugs, rapidly progressive symptomatic disease (for M1)
Docetaxel Cabazitaxel
50
Immunotherapy, asymptomatic or minimally symptomatic (for M1)
Sipuleucel-T
51
Bone metastases w/ no visceral disease (for M1)
Radium-223
52
MSI-H or dMMR (for M1)
Pembrolizumab
53
Mutations in DNA repair genes (for M1)
PARP inhibitors Olaparib Rucaparib
54
PSMA-targeted therapy (for M1)
Lutetium-177-PSMA-617
55
Drugs that require Steroids with dose
Abiraterone** req concurent use Cabazitaxel Docetaxel
56
Abiraterone (Zytiga) info
** food inc bioavailability X 17, higher toxicity..1hr before or 2hr after** ** absence of prednisone = aldosterone overactivity** CSPC = 1000mg QD + pred 5mg QD CRPC = 1000mg QD + pred 5mg BID
57
Fine particle formulation Abiraterone (Yonsa)
For: Metastatic CRPC Cant switch from one to other form 500mg QD combo w/ methylpred BID Can admin w/ or w/o food generic, dont use hepatic dysfunction
58
Enzalutamide (Xtandi) info
indications: Metastatic CRPC, non-metastatic CRPC, metastatic CSPC Dose: 160mg QD, should also receive LHRH agonist inc risk of falls, fractures, seizure risk
59
Enzalutamide (Xtandi) info
indications: Metastatic CRPC, non-metastatic CRPC, metastatic CSPC Dose: 160mg QD, should also receive LHRH agonist inc risk of falls, fractures, seizure risk
60
Apalutamide info
Indications: Metastatic CSPC, Non-metastatic CRPC Dose: 250mg QD
61
Darolutamide info
Indications: Non-metastatic CRPC, Metastatic CSPC (combo w/ docetaxel) Dose: 600mg BID w/ food Less CNS pen/toxicity
62
Chemotherapy for CRPC
Docetaxel = used 1st Cabazitaxel = after docetaxel failure
63
Docetaxel info
75mg/m2 IV Q3 week + pred 5mg BID continuously V myleosuppressive CI: ANC < 1,500 Pre-med: Dexamethasone 8mg PO at 12/3/1 hr before txm
64
Cabazitaxel info
25mg/m2 IV Q3 week + pred 10mg QD Low dose = 20mg/m2 Pre-medicate = antihistamine + corticosteroid + h2 antagonist
65
Pre-medicate for Cabazitaxel
Benadryl 25mg IV + Dexamethasone 8mg IV + Famotidine 20mg
66
Sipuleucel-T (Provenge)
"cancer vaccine" Indication: asymptomatic or minimally symptomatic mCRPC + > 6 month life expectancy collect WBC from pt, expose to PAP-GM-CSF -> infuse back into pt to fight cancer
67
Radium-223 (Xofigo) info
Indications: CRPC, symptomatic bone metastases, no known visceral metastases Admin: IV over 1min, 1.35microcuries(50kBq)/kg Q 4 weeks for 6 doses
68
Radium-223 (Xofigo) cautions
**Dont use with abiraterone** Limited to pts w/ bone metastases without other clinically significant sites of disease
69
Pembrolizumab (Keytruda) info
Indication: unresectable or MSI-H or MMR-deficienct solid tumors who have progressed on prior treatment and who have no satisfactory alternative treatment options Admin = 200mg IV Q3 weeks or 400mg IV Q 6 weeks

CDM 4 Exam 3 (11 decks)

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