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GU > Prostate > Flashcards

Prostate Flashcards

1
Q

survey or rad prostatectomy?

A

PIVOT trial: NEJM 2012 Wilt: 14% of target enrolled; no difference in disease-specific mortality; if: higher PSA, higher baseline risk, higher gleason–> trend of benefit for surgery

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2
Q

active surveillance regimen for diagnosed cancer

A

repeat biopsy at baseline, then upon progression of PSA, if no progression every 3 years; q6mo PSA and DSE

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3
Q

PSA rise–> when to think local

A

if extra capsular extension and late rise–>likely local;

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4
Q

PSA doubling time (PSADT) cutoff for risk estimation

A

if <3mo after surgery/radiation (1/5 of population), likely to develop mets and die of cancer

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5
Q

castration resistant

A

tumors not hormone-refractory, they just grow with lower levels

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6
Q

intermittent androgen deprivation

A

reduced toxicity, does not delay castrate-resistance, improved quality of life: NEJM Hussain (if low PSA at 6 months, do intermittent: unable to conclude non-inferiority); other trials show equivalence–> NOW STANDARD to treat 6 months then d/c if PSA drops to <4

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7
Q

if PSA goes down and bone scan worse

A

flare phenomenon–> repeat second scan, look for NEW lesions

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8
Q

TROPIC trial

A

cabazitaxel in docetaxel-refractory–> OS benefit

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9
Q

enzalutamide/xtandi

A

binds and inhibits AR, also inhibits transport to nucleus and binding to DNA (also taxanes inhibit transport to nucleus)

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10
Q

prostate ca epi

A

1st in men 220k, 2nd most cause of death

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11
Q

rising PSA with no mets

A

60,000 of patients, proportion develop clinical mets

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12
Q

castrate resistant

A

means that castrate levels of testosterone but still progression

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13
Q

paradigm for prostate ca treatment

A

intervene if Sx, or if risk of significant event might occur is high

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14
Q

prostate cancer biospy

A

12-14 cores

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15
Q

prostate cancer screening

A

T3a- extracapsular, T3b- seminal vescles

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16
Q

nodal disease in prostate ca

A

pelvic nodes good prognosis, outside pelvis bad

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17
Q

calculating risk of early stage prostate

A

need nomogram, which is still work in progress. T-stage alone insufficient

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18
Q

localized prostate cancer risk assessment

A

if low risk, recommend 2nd biopsy. repeat biopsy with 24-30 cores to ensure sampling. alternative is MRI prostate to look for dominant lesion. low risk if no lesion. biopsies being guided using fused MRI/US imaging for adequate sampling

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19
Q

active surveillance scheduling

A

every 6 months

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20
Q

biochemical recurrence mgmt

A

use nomogram to predict liklihood of localized recurrence and benefit from RT

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21
Q

first line therapy with PFS rise

A

use nomogram. if <3month PSA doubling, more likely to have mortality. treat with antigen depletion (castration)

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22
Q

androgen depletion–> intermittent or continuous?

A

GnRH agonist + AR antagonist for 7 months for 7 months, . reduced toxicity and improved quality of life. does not delay development of resistance. non-inferiority. 13 trials–> no difference.

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23
Q

bisphos or denosumab in prostate

A

shown to delay SRE

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24
Q

causes of castrate resistance

A

up regulation of androgen receptor, or up regulation of androgen synthesis

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25
Q

slow drift up of PSA with enzalutamide

A

do not stop…still effective. symptom-based may be way to go

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26
Q

abiaraterone versus enzalutamide

A

prior response doesn’t predict response, but responses are lower in patients who don’t respond to one

27
Q

high volume (4+ bone lesions) newly diagnosed metastatic prostate cancer

A

unsure of addition of docetaxel at front-line, one trial showed survival benefit, another showed no difference

28
Q

DRE palpation

A

only peripheral zone, 70% of cancers. transition zone not evaluable

29
Q

familial prostate

A

10%; highest risk SNP is in HOXB13 TF

30
Q

adeno confirmation v. benign

A

expresion of alpha-methylacyl-coenzyme A racemase

31
Q

translocations in pr ca

A

TMPRSS2-ERG fusion.

32
Q

chemoprevention

A

analysis shows that you can avoid 4 low-grade tumors for 1 high grade- not recommended for healthy men. No OS benefit

33
Q

AUA PSA recommendations

A

shared decision for age 55-69; otherwise no

34
Q

PSA predictors

A

PSA 4: 23% PPV; PSA velocity >0.75/yr and PSA 4-10–> suspicious

35
Q

number cores needed for TRUS Bx

A

12

36
Q

free psa

A

% less than 25% is associated with +cancer. not recommended clinically to make decision

37
Q

pelvic MRI recommendation

A

if T3/T4 (thru capsule or fixed/invasion) or nomogram LN risk >20%.

38
Q

bone mets prostate

A

more often blastic.

39
Q

bone scan recommended if

A

PSA >20, gleason 8, T3/T4 (capsule invasion), or Sx

40
Q

PSA elevation after prostatectomy

A

median 8 years to Sx; higher risk - time to progression short, high glassine, high doubling time

41
Q

Tx of PSA elevation after prostatectomy

A

no gold standard of whether to start ADT. can do intermittent with similar disease-specific survival

42
Q

RT v. prostatectomy v. observe

A

can use nomograms.

43
Q

biochem relapse after RT

A

nadir + 2.0 points

44
Q

RT dose for prostate

A

78-79Gy.

45
Q

ADT after prostate RT

A

needed for intermediate disease (6 months, if PSA velocity >2.0/yr). if node-posalsitive, need 2 years adjuvant ADT.

46
Q

RT following prostatectomy

A

pT3 (capsule penetration), positive margins, detectable PSA after surgery.

47
Q

salvage RT following prostatectomy

A

consider if PSA relapse and low risk features (i.e. >1 yr from surgery, glee 7, no LN or seminal vesicle invasion at surgery)

48
Q

denosumab to prevent fracture on ADT

A

need 60mg SQ every 6 months. effective

49
Q

bone flare on ADT

A

3-6 months after initiation of therapy

50
Q

PSA to assess initial ADT response

A

7 month PSA: 4 high risk

51
Q

ADT combined blockade versus just GnRH

A

modest improvement in survival. anti-androgen alone is inferior.

52
Q

anti-androgens

A

flutamide, bicalutamide, nilutamide.

53
Q

ADT after prostectomy

A

no

54
Q

intermittent v continuous ADT for metastastic

A

data not conclusive. intermittent not non-inferior. however meta-analysis shows same OS and improved QOL

55
Q

docetaxel + ADT for newly metastatic

A

survival benefit for visceral disease, or 4+ boney sites. only 1 study

56
Q

medical castration

A

defined as testosterone

57
Q

newly castrate resistant disease

A

trial of anti-androgen withdrawl, and consider second ant9-androgen or ketoconazole or hydrocortisone (non-cross-resistant sometimes)

58
Q

abiatarone

A

oral CYP17 inhibitor + prednisone, blocks androgen synth. 1g daily plus prednisone 5mg BID

59
Q

enzalutamide

A

another potent anti-androgen,

60
Q

sipuleucel-T

A

autologous vaccine of prostatic acid phosphatase and G-CSF, q2wks x 3

61
Q

docetaxel for prostate

A

75mg/m2 q3wk + prednisone

62
Q

cabazitaxel for prostate

A

25mg/m2 + 10mg day predinsone. improved survival. consider G-CSF given high rates of neutropenia

63
Q

alpharadin

A

approved for symptomatic bone mets (cannot have visceral disease), improved survival.

64
Q

regimens for adrenocortical caricinoma

A

surgery. poor prognosis if >5cm. mitotane. adding EDT (etoposide, doxorubicin, cisplatin) improves PFS but not OS.

GU (4 decks)

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