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Oncology > Prostate > Flashcards

Prostate Flashcards

1
Q

Most important risk factors associated with prostate cancer?

A

Age, race and positive family history

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2
Q

What mutation is associated with positive family history and young age for prostate cancer?

A

HOXB13

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3
Q

What are the subtypes of prostate cancer?

A 
adenocarcinoma (95%)
mucinous adenocarcinoma
small cell
large cell
sarcomatoid
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4
Q

Prostate cancer stage is based on what 3 factors?

A

TNM stage
PSA
Gleason Score

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5
Q

What are the two main categories of prostate cancer?

A

Localized and Metastatic

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6
Q

What are t stages for prostate cancer?

A 
T1: no appreciated on exam or imaging
T2: confined to prostate 
-T2a: 50% 1 lobe, 
-T2c: both lobes
T3: outside prostate (T3b: seminal vesicle involvement)
T4: into adjacent tissues
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7
Q

Most important T stage, Gleason Score and PSA? Why?

A

T2B, 7, 10-20; helps determine Intermediate risk

Low is Int

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8
Q

What are treatment options for localized prostate cancer?

A

Surgery, RT or watchful waiting

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9
Q

Which risk group is appropriate for watchful waiting?

A

Low risk (Gleason

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10
Q

When after prostatectomy do you immediately give ADT? Data?

A

Node positive disease; Messing et al, significant improvement in PFS and OS at 11.9 years

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11
Q

Who gets ADT with RT for localized disease? And for how long?

A

Intermediate risk: 3-4 months
High risk: 2-3 years
Clinical node positive or T3: indefinite (would recommend surgery here)

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12
Q

What are side effects of ADT?

A 
hot flashes
fatigue
loss of libido
impotence
weight gain
loss of bone density (can start as early as 6 months)
reduced lean mass
increased LDL, reduced HDL, increased Triglycerides
reduced insulin sensitivity
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13
Q

What should be done to minimize bone loss?

A 
Dexa scan at start and regular intervals
calcium (>1200 mg/d)
vitamin D (>800 IU/d)
aerobic/ resistance exercises
smoking cessation
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14
Q

When are bisphosphonates prescribed for prostate cancer? Why?

A

Only in castrate resistant setting

  • prevents skeletal related events (RT to bone, fracture, cord compression or surgery to bone)
    • otherwise only given for therapy in patients with severe osteopenia or porosis (T score > 2.0)
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15
Q

Is cardiovascular-related mortality increased due to prolonged ADT therapy?

A

No

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16
Q

When after prostatectomy do you do radiation? What are common adverse effects?

A

positive surgical margins
extracapsular extension
involvement of seminal vesicles or pT3
- rectal, uretheral strictures and incontinence

17
Q

What is PSA level post-prostatectomy for biochemical recurrence?

A

> 0.2 x 2 with no evidence of metastatic disease

18
Q

Why is biochemical recurrence difficult to assess post-RT?

A

there may be residual prostatic tissue; nadir may take up to a year; usually considered significant for biochemical recurrence if 2ng/mL above nadir

19
Q

What is PSA cut-off by ASTRO for salvage RT in localized prostate cancer?

20
Q

For metastatic prostate cancer at presentation, if low volume, what is initial tx option and when is PSA measurement predictive of prognosis?

A 
androgen blockade ( mono or dual )
7 months predicts medial survival
-PSA>4 = 13 months
-PSA 0.2-4 = 44 months
-PSA
21
Q

What should you always check before determining someone has castrate-resistant prostate cancer? (2 things)

A

-Testosterone,

22
Q

When can intermittent hormone blockade be used?

A

only localized disease with biochemical recurrence

23
Q

When must continuous hormone blockade be used?

A

metastatic disease (SWOG 9346, Hussain, NEJM 2013)

24
Q

When should chemotherapy be used for metastatic cancer as first line therapy?

A

high volume of disease

  • visceral metastasis
  • 4 or more bone lesions (1 beyond pelvis & axial skeleton)
  • median OS 57.6 months versus 44 months, HR 0.61, P=0.003, CHAARTED, E3805 trial)
25
Q

What must consider for rapid disease progression, especially if visceral metastasis with low PSA rise?

A

small cell conversion

26
Q

What are advanced androgen blockade agents? Their mechanism of action? In what setting can the be used?

A

Abiraterone = irreverisble inhibitor of CYP-17A (HTN, LE edema & LFT rise)
Enzalutammide = binds androgen receptor and prevents nuclear translocation (fatigue, diarrhea, hot flashes, seizures)
- both in pre-docetaxel and post-docetaxel

27
Q

What immunotherapy is approved for metastatic castrate resistant prostate cancer?

A

Sipuleucal T for asymptomatic or minimally

- median OS 25.8 versus 21.7 months (IMPACT trial)

28
Q

When is Radium-223 given in prostate cancer? How does it work?

A

alpha emitter and calcium mimetic

- pretreated or unfit for docetaxel with symptomatic bony disease

Oncology (7 decks)

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