Oncology Flashcards
PSA screening recommendations
Age - offer PSA testing every 2 yrs from 50-69
FHx
- one first degree relative 2.5-3x risk - from >45yrs
- 3x first degree relatives - from > 40 yrs
Prostate cancer investigations
Indicated if elevated PSA +/- abnormal DRE
MRI prostate
Multifocal core biopsy
Features suspicious of metastatic prostate cancer
PSA > 100ng/dl
Distribution of metastatic disease - sclerotic bone metastases
Prostate management options
Localised
- prostatectomy
- radiotherapy
Advanced disease
- hormonal therapy/bilateral orchiectomy
- chemotherapy
- supportive therapy –> RTx, bisphosphonates, palliative care
MOA of androgen deprivation therapy
ADT –> reduce GnRH –> reduce LH –> reduce testicular testosterone production
Side effects of ADT
Vasomotor symptoms
Reduced libido
Bone density loss
Muscle mass loss
Cardiovascular risk factors
Estrogen deficiency - gynaeocomastia, hot flushes
Testosterone deficiency - erectile dysfunction, diabetes, muscle weakness
Relationship between testosterone and estradiol
Testosterone converts to estrogen via CYP19/aromatase
Chemotherapy for prostate cancer
Taxanes - docetaxel, cabazitaxel
Used in combination with ADT for “high volume” disease, visceral metastases, multiple bone metastases
MOA of taxane chemotherapy
Interferes with microtubule growth, causing cell arrest in G2/M phase
Inactivates bcl-2 –> apoptosis
Side effects of taxane chemotherapy
Hair loss
N+V
Pancytopenia
Mucositis/diarrhoea
Lethargy
Fluid retention
Hypersensitivity reactions
Myalgias and arthralgias
Peripheral neuropathy
Nail changes
Examples of direct androgen receptor antagonist
Enzalutamide
Apalutamide
Darolutamide
Examples of androgen biosynthesis inhibitor (17a-hydroxylase)
Abiraterone
Blocks synthesis of testosterone in adrenal gland via inhibition of 17a-hydroxylase and C17,20-lyase activity
Mechanism of cortisol inhibition of abiraterone
Abiraterone (androgen biosynthesis inhibitor via 17a hydroxylase)
ACTH rises in response to increase in deoxycortisterone (due to decrease in 17OH-progesterone) –> leads to decrease in cortisol (thus should have mandatory concurrent steroids)
Also results in increased shunting, causing excess mineralocorticoid (hyperaldosteronism)
Side effects of direct androgen receptor antagonists
Fatigue
Cognitive impairment
Falls
Seizures
Rash
Side effects of androgen biosynthesis inhibitor
Cardiac toxicity
Hypertension
Concurrent steroids
Bone protection methods for prostate cancer
Calcium and vitamin D supplementation
Weight bearing exercise
DEXA scan monitoring
High risk - denosumab, ZA
Common complications of prostate cancer
Acute urinary retention
Bilateral ureteric obstruction
Spinal cord compression
Pancytopenia from BM infiltration
Bilateral lower limb lymphoedema secondary to pelvic obstruction
Genetic defects in prostate cancer
Aberrations in ~1/3rd of pts
BRCA2 most common alteration seen
Testicular cancer classification
Pure seminoma - AFP not elevated
Non seminoma/mixed germ cell tumour - often elevated
Testicular cancer epidemiology
Most commonly seen in 25-40 yrs
Median age at diagnosis is 33 yrs
Increased risk with cryptorchidism
5 yr relative survival ~98%
Tumour markers for prostate cancer
AFP, beta HCG, LDH
Role of AFP and beta HCG
Useful for surveillance/follow up
Associated with prognosis and used to guide treatment in advanced disease
Treatment of testicular cancer
Localised disease
- Orchiectomy
- Surveillance
Metastatic/advanced disease
- Chemotherapy (Bleomycin, etoposide, platinum)
- Resection of residual masses
Relapsed/refractory disease
- Second line chemotherapy
- High dose chemo and mini-autografts
Toxicities associated with chemotherapy for testicular cancer
Pancytopenia, alopecia, lethargy
Cisplatin
- Hearing impairment
- Tinnitus
- Peripheral neuropathy
- Renal impairment
Bleomycin
- Hypersensitivity
- Pneumonitis/lung toxicity