Malignancy: Prostate Cancer Flashcards
Most prostate cancer cases are diagnosed after what age?
65
Most prostate cancer cases occur in what ethnicity?
Black-african
What are the presenting symptoms of advanced prostate cancer? (it is usually asymptomatic at diagnosis)
Urinary outflow obstruction.
Pelvic or back pain due to bone metastases.
In patients with low-risk localised prostate cancer, and those at intermediate risk who decline radical treatments, active monitoring is an option.
What does this involve?
Close monitoring to avoid unnecessary treatment until disease progression occurs (or until the patient requests treatment)
What is androgen deprivation therapy? (2)
This involves the use of either a luteinising-hormone releasing hormone (LHRH) agonist (buserelin, goserelin, leuprorelin acetate, or triptorelin), OR bilateral orchidectomy - which removes the supply of the endogenous hormone. Androgen deprivation therapy may be continued for up to 3 years in patients with high-risk localised prostate cancer.
Androgen deprivation therapy involves the use of a luteinising hormone-releasing hormone (LHRH) agonist OR a bilateral orchidectomy which removes the supply of endogenous hormone.
What are some LHRH agonists? (
- Buserelin
- Goserelin
- Leuprorelin acetate
- Triptorelin
What are the main side effects of androgen deprivation therapy?
- Urinary and sexual dysfunction
- Loss of fertility
- Radiation-induced enteropathy
- Hot flushes
Tumour flare, due to an initial surge in testosterone concentrations can occur in the initial stages of treatment with androgen deprivation therapy. How can this be managed?
The prophylactic use of anti-androgen therapy such as cyproterone acetate has been used.
Can prostate cancer patients used PDEV inhibitors?
Yes - they should have access to specialist ED services.
Osteoporosis and fatigue can occur with androgen deprivation therapy. If a bisphosphonate it not suitable, what is an alternative?
Denosumab.
Gynaecomastia can occur with bicalutamide treatment of what duration?
Long-term, longer than 6 months.
What is bilateral orchietomy?
Testicle removal, both.
In the treatment of metastatic prostate cancer, bilateral orchidectomy should be offered to all patients. Understandably, this is not an appealing option for many men.
Anti-androgen monotherapy with bicalutamide can be offered to those who are willing to accept what?
Anti-androgen monotherapy with bicalutamide [unlicensed indication] can be offered to those who are willing to accept the adverse impact on overall survival and gynaecomastia in the hope of retaining sexual function. However, if satisfactory sexual function is not maintained, stop bicalutamide and start androgen deprivation therapy.
In patients who develop hormone-relapsed metastatic tumour, chemotherapy with what can be used? What length should treatment be limited to?
For patients who develop hormone-relapsed metastatic tumour, chemotherapy with docetaxel can be used.
It is recommended to stop the treatment with docetaxel after 10 cycles, or if severe adverse events occured.
In patients with hormone-relapsed prostate cancer, what can be offered as third line therapy, after androgen deprivation therapy and anti-androgen therapy?
A corticosteroid such as dexamethasone.
