Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Uro Onc > Prostate > Flashcards

Prostate Flashcards

1
Q

PCa

Localized Workup

6

A
  • H&P including DRE
  • Labs including PSA and PSAD
  • Review PBx
  • Estimate Life Expectancy
  • Obtain FH (Somatic and germline testing if needed)
  • Assess QoL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PCa

Regional and Metastatic Workup

6

A
  • H&P including DRE
  • Labs including PSA and PSAD
  • Imaging (CT/ Bone Scan, mpMRI, PSMA-PET)
  • Estimate Life Expectancy
  • Obtain FH (Somatic and germline testing if needed)
  • Assess QoL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PCa

Low Risk Treatment

4

A
  • Active Surveillance (p)
  • RT (EBRT or Brachytherapy)
  • RP
  • Observation (< 10y Life expectancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PCa

PCa Epidemiology

2

A
  • Incidence- 288,300 new cases (1 in 8)
  • Deaths- 34,700 deaths (1 in 41)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PCa

Grade Groups for PCa

5

A

Grade group 1: 3+3
Grade group 2: 3+4
Grade group 3: 4+3
Grade group 4: Gleason 8 (3+5, 5+3, 4+4)
Grade group 5: Gleason 9 or 10 (4+5, 5+4, 5+5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PCa

PCa T1 staging

3

A

T1a → <5% of tissue removed, incidental during unrelated sx

T1b → >5% of tissue removed, incidental during unrelated sx

T1c → cancer found on biopsy, usually related to elevated PSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PCa

PCa T2 staging

3

A

T2a → in only < 50% of one lobe

T2b → in > 50% of one lobe

T2c → cancer in both lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PCa

PCa T3 staging

2

A

T3a → Extracapsular extension

T3b → SV invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PCa

PCa T4 staging

1

A

T4 → spread to nearby organs (rectum, bladder, levator muscles, pelvic wall)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCa

N staging

1

A

N1 -> Regional LN metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PCa

M staging

3

A

M1a -> non-regional LN metastasis
M1b -> boney metastasis
M1c -> Viseral metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PCa

PCa Risk Stratification → Very Low Risk

6

A

Very Low Risk must have all:
* PSA < 10
* GG1 (Gl 6)
* T1-T2a
* < 34% total biopsy cores positive
* no core >50% involved
* PSA density < 0.15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PCa

PCa Risk Stratification → Low Risk

3

A

Low Risk must have all:

  • PSA < 10
  • Grade Group 1
  • T1-T2a
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PCa

PCa Risk Stratification → Intermediate Risk

5

A

Intermediate Risk:

  • PSA 10-20 OR
  • GG 2-3 OR
  • T2b-c
  • Favorable GG1: (with PSA 10 - <20) or GG2, <50% positive cores
  • Unfavorable: >50% positive cores or T2b-c or GG3 (PSA < 20)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PCa

PCa Risk Stratification → High Risk

3

A

High Risk:

  • PSA >20 OR
  • GG 4-5 OR
  • _>_T3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PCa

PCa Epidemiology

2

A
  • Incidence- 288,300 new cases (1 in 8)
  • Deaths- 34,700 deaths (1 in 41)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PCa

PCa African Ancestry Disparties

6

A
  • Incidence 60-70% higher
  • Mortality 2-4 times higher
  • 1.2-5.1 years earlier diagnosis
  • More aggressive
  • Increased risk of metastatic progression
  • More advanced at presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PCa

PCa Biomarker Tests

10

A
  • PSA (blood)
  • fPSA (blood)
  • PCA3 (urine)
  • PHI (blood)
  • 4k score (blood)
  • ExoDx (urine)
  • Select MDx (urine)
  • Confirm MDx (tissue)
  • IsoPSA (blood)
  • MyProstateScore (blood and urine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PCa

ASAP and PIN risk

A
  • ASAP- 40% cancer risk
  • PIN- 20-30% cancer risk
20
Q

PCa

Favorable Int Risk Treatment

3

A
  • AS
  • EBRT or Brachytherapy
  • RP +/- LND
21
Q

PCa

Unfavorable Int Risk Treatment

4

A

_>_10y LE
* RP + LND
* RT + 4-6m ADT (EBRT, EBRT with Brachytherapy boost, Brachytherapy)

<10y LE
* RT +4-6m ADT (EBRT)
* Watchful waiting

22
Q

PCa

High Risk Treatment

6

A

> 5y or symptoms
* RP + LND
* RT + 1.5-3y ADT (EBRT, EBRT with Brachytherapy boost)
* RT + 3y ADT + Abiraterone (very high risk)

_<_5y and no symptoms
* Watchful waiting
* ADT
* EBRT

23
Q

PCa

N1 Treatment

6

A

> 5y or symptoms
* EBRT + 3y ADT + Abiraterone (p)
* EBRT + 1.5-3y ADT
* ADT + Abiraterone
* RP + LND (select pts)

_<_5y and no symptoms
* Watchful waiting
* ADT

24
Q

PCa

List of Post-RP adverse features

4

A
  • Positive margin
  • Extracapsular extension
  • SV invasion
  • Detectable PSA
25
Q

PCa

Adjuvant therapay post RP with adverse features

4

A

Adverse features
* Monitoring (p)
* EBRT +/- ADT

N1
* Monitoring
* ADT +/- EBRT

26
Q

PCa

Post RP PSA persistence/recurrence

5

A

Imaging negative
* EBRT +/- ADT 3y (p)
* Monitoring

Fossa recurrence
* EBRT +/- ADT 3y (p)
* Monitoring

Pelvic LN mets on imaging
* EBRT + ADT 3y +/- Abiraterone

27
Q

PCa

Post RT PSA Recurrence

6

A

Imaging negative
* Consider prostate/SV biopsy and monitoring
* ADT based on PSADT
* Local secondary treatment

Pelvic LN mets on imaging
* Consider prostate/ SV biopsy and monitoring
* ADT +/- Abiraterone
* Local secondary treatment +/- ADT

28
Q

PCa

M0 CSPC s/p maximal pelvic therapy

3

A
  • Monitoring (p)
  • ADT
  • Enzalutamide + ADT (select pts)
29
Q

PCa

M0 CRPC s/p maximal pelvic therapy

3

A

PSADT > 10m
* ADT + Monitoring (p)
* ADT + Secondary hormone therapy

PSADT< 10m
* ADT + Apalutamide or Darolutimide or Enzalutimide

30
Q

PCa

High volume PCa definition

2

A
  • Visceral metastasis
  • > /= 4 bone lesions with at least 1 beyond the vertebral body/ pelvis

Based on CHAARTED criteria

31
Q

PCa

High volume M1 CSPC (synchronous or metachronous)

2

A
  • ADT + Docetaxel + Abiraterone or Darolutimide
  • ADT + Abiraterone or Apalutamide or Enzalutimide
32
Q

PCa

Low volume M1 CSPC (synchronous)

3

A
  • ADT + Docetaxel + Abiraterone or Darolutimide
  • ADT + Abiraterone or Apalutamide or Enzalutimide
  • ADT + EBRT to primary +/- Abiraterone or Docetaxel
33
Q

PCa

Low volume M1 CSPC (metachronous)

1

A
  • ADT + Abiraterone or Apalutamide or Enzalutimide
34
Q

PCa

Denovo M1 CSPC Workup

7

A
  • H&P including DRE
  • Labs including PSA and PSAD
  • Imaging (CT/ Bone Scan, mpMRI, PSMA-PET)
  • Estimate Life Expectancy
  • Obtain FH
  • Somatic and germline genetic testing
  • Assess QoL
35
Q

PCa

LHRH Agonist vs Antagonist

5

A

Agonist
* Leuprolide (Lupron)
* Goserelin (Zoladex)
* Triptorelin (Trelstar)

Antagonist
* Degarelix (Firmagon)
* Relugolix (Orgovyx)

36
Q

PCa

SHIM score

12

A
  • Sexual Health Inventory for Men
  • 5 questions, score 1-5
  • confidence in getting and keeping an erection? hard enough for penetration? maintain erection after penetration? maintain erection to completion? satisfaction?
  • 1-7: severe
  • 8-11: moderate
  • 12-16: mild-moderate
  • 17-21: mild
  • 22-25: no ED
37
Q

PCa

IPSS score

13

A
  • International prostate symptom score
  • 7+1 questions
  • Incomplete emptying? frequency less than 2 hours? intermittent stream? urgency? weak stream? strain? nocturia? bother?
  • 0-7: mild
  • 8-19: moderate
  • 20-35: severe
38
Q

PCa

M1 CRPC pre-treatment workup

4

A
  • Metastatic lesion biopsy
  • Somatic testing for homologous recombination repair (HRR), microsatellite instability (MSI)/ mismatch repair deficiency (dMMR) and tumor mutational burden (TMB)
  • Continue ADT
  • Denosumab (p) or Zoledronic acid +/- palliative RT
39
Q

PCa

Small cell/ neuroendocrine prostate cancer

4

A
  • Cisplatin/ etoposide
  • Carboplatin/ etoposide
  • Docetaxel/ carboplatin
  • Cabazitaxel/ carboplatin
40
Q

PCa

M1 CRPC treatment (no prior docetaxel/ no prior novel hormone therapy)

9

A
  • Abiraterone (p)
  • Docetaxel (p)
  • Enzalutimide (p)
  • Niraparib/ abiraterone (BRCA)
  • Olaparib/ abiraterone (BRCA)
  • Pembrolizumab (MSI-high/ dMMR)
  • Radium-223 (symptomatic bone mets)
  • Sipuleucel-T (minimal symptoms)
  • Talazoparibe/ enzalutimide (HRR)
41
Q

PCa

M1 CRPC treatment (failed prior docetaxel/ no prior novel hormone therapy)

11

A
  • Abiraterone (p)
  • Cabazitaxel (p)
  • Enzalutimide (p)
  • Cabazitaxel/ carboplatin
  • Mitoxantrone (palliative)
  • Niraparib/ abiraterone (BRCA)
  • Olaparib/ abiraterone (BRCA)
  • Pembrolizumab (MSI-high/ dMMR)
  • Radium-223 (symptomatic bone mets)
  • Sipuleucel-T (minimal symptoms)
  • Talazoparibe/ enzalutimide (HRR)
42
Q

PCa

M1 CRPC treatment (no prior docetaxel/ failed prior novel hormone therapy)

10

A
  • Docetaxel (p)
  • Olaparib (BRCA) (p)
  • Rucaparib (BRCA) (p)
  • Cabazitaxel/ carboplatin
  • Niraparib/ abiraterone (BRCA)
  • Olaparib (HRR)
  • Pembrolizumab (MSI-high/ dMMR)
  • Radium-223 (symptomatic bone mets)
  • Sipuleucel-T (minimal symptoms)
  • Talazoparibe/ enzalutimide (HRR)
43
Q

PCa

M1 CRPC treatment (failed prior docetaxel/ failed prior novel hormone therapy)

9

A
  • Cabazitaxel (p)
  • Docetaxel rechallenge (p)
  • Cabazitaxel/ carboplatin
  • Lutetium Lu 177 vipivotide tetraxetan (PSMA + lesions)
  • Mitoxantrone (palliative)
  • Olaparib (HRR)
  • Pembrolizumab (MSI-high/ dMMR/ TMB >10)
  • Radium-223 (symptomatic bone mets)
  • Rucaparib (BRCA)
44
Q

PCa

Germline testing

9

A
  • BRCA 1/2
  • ATM
  • PALB2
  • CHEK2
  • HOXB13
  • MLH1
  • MSH2
  • MSH6
  • PMS2
45
Q

PCa

Somatic Tumor Testing

5

A
  • HRR (BRCA 1/2, ATM, PALB2, FANCA, RAD51D, CHEK2, CDK12)
  • MSI-H
  • dMMR
  • TMB
  • ctDNA
46
Q

Ductal Carcinoma

2

A
  • is associated with high grade disease and recurrence
  • should be graded as 4+4
47
Q

Outcomes of genomic testing

A
  • Oncotype Dx- likelihood of Gleason 3+4 or ECE at prostatectomy
  • Decipher and Prolaris- likelihood of mets or CSS
  • Confirm MDx and Mitomic- likelihood of cancer after negative biopsy

Uro Onc (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions