Prostate Cancer

Question 1

The most commonly diagnosed cancer for Men

Answer 1

Prostate Cancer

Question 2

Treatment Plan for Prostate Cancer

Answer 2

Localized prostate cancer can be cured by surgery
or radiation therapy, but advanced prostate cancer
is not yet curable.

Question 3

Risk Factors: 
Age
Race
Genetics
Mutations
occupational 
Diet 
Decreased Intake

Answer 3

Age:More than 70% of cases are diagnosed in men greater than 65 years old.
Race: African Americans have higher incidence and death rate.
Genetic Familial prostate cancer is inherited in an autosomal dominant manner.
Mutations in p53, Rb, E-cahedrin, a-catenin, androgen receptor,,microsatellite instability. Candidate prostate cancer gene locus identified on chromosome 1.
Occupational: Increased risk associated with cadmium exposure.
Diet: Increased risk associated with high-meat and high-fat diets.
Decreased intake of 1, 25-dihydroxyvitamin D, vitamin E, lycopene, and bcarotene increases risk.

Question 4

Is Prostate Cancer Hormonal?

Answer 4

Hormonal Does not occur in eunuchs. Low incidence in cirrhotic patients
(why?). Up to 80% are hormonally dependent. African-Americans have 15%
increased testosterone. Japanese have decreased 5-a-reductase activities.
Polymorphic expression of the androgen receptor.

Question 5

Currently, the most promising agent for the prevention of prostate cancer is

Answer 5

finasteride, a 5-α-reductase inhibitor
used for BPH.
Other agents, including selenium, vitamin E, lycopene,
green tea, nonsteriodal anti-inflammatory agents,
isoflavones, and statins, are under investigsation for
prostate cancer and show promise.

Question 6

Screening for Prostate

Answer 6

1-Digital rectal examination (DRE).

2- Prostate specific antigen (PSA)

Question 7

Pathophysiology Prostate Cancer

Answer 7

The growth and development of the prostate is
under control of androgens, and it is well known
that men who undergo castration prior to
puberty do not develop prostate cancer.
Antiandrogens inhibit the formation of the DHTreceptor complex and thereby interfere with
androgen-mediated action at the cellular level.

Question 8

Localized Disease

Advanced Disease

Answer 8

Asymptomatic.
Locally Invasive Disease
• Ureteral dysfunction, frequency, hesitancy, and dribbling
• Impotence.
Advanced Disease:
• Back pain
• Cord compression
• Lower extremity edema
• Pathologic fractures
• Anemia
• Weight loss

Question 9

Prostate Therapy

Answer 9

Androgen deprivation for 2 years

greater than 20 ng/mL and RT or RT or RP

Question 10

What’s Expectant Management

Answer 10

observation or watchful waiting, involves monitoring the course of disease and initiating treatement if the cancer progresses or the patient becomes symptomatic.

Question 11

Orchiectomy:

Answer 11

Bilateral orchiectomy, or removal of the testes, rapidly
reduces circulating androgens to castrate levels
(androstenedione less than 50 ng/mL, 1.7 nmol/L).

Question 12

Radiation common methods:

Answer 12

The two commonly used methods for
radiation therapy are external-beam
radiotherapy and brachytherapy.

Question 13

Complications from radical prostatectomy

include

Answer 13

blood loss, stricture formation,
incontinence, lymphocele, fistula
formation, anesthetic risk, and impotence

Question 14

LHRH agonists MOA

Types of Drugs

Answer 14

LHRH agonists are a reversible method of androgen
ablation and are as effective as orchiectomy in
treating prostate cancer. Currently available LHRH
agonists include leuprolide, leuprolide depot,
leuprolide implant, and goserelin acetate implant.

Question 15

The most common adverse effects reported with LHRH

agonist therapy include

Answer 15

a disease flare-up during the
first week of therapy, hot flashes, erectile impotence,
decreased libido, and injection-site reactions.

Question 16

LHRH antagonists -
MOA
Treatment

Answer 16

These drugs work in a slightly different way from the
LHRH agonists, but they lower testosterone levels more quickly and don’t cause tumor flare like the LHRH agonists do.
Treatment with these drugs can also be considered a form of medical castration.

Question 17

LHRH antagonists drugs-

Answer 17

Degarelix (Firmagon) is given as a monthly injection under the skin. Some men may notice problems at the injection site (pain, redness, and swelling).  Relugolix (Orgovyx) is taken as pills, once a day, so it might
allow for less frequent office visits.

Question 18

Antiandrogens Drugs:

Answer 18

Three antiandrogens, flutamide, bicalutamide, and

nilutamide,

Question 19

Why are androgens used/ not used

Answer 19

antiandrogens is less effective than LHRH
agonist therapy.
Objective responses are manifested as decreased
bone pain, decreased prostate size, decreased
PSA, and/or improved performance state

Question 20

Antiadrogens Side effects

Answer 20

Gynecomastia, Hot flushes, 
Gastrointestinal disturbances (diarrhea)

Question 21

Combined Hormonal blockade

Answer 21

The rationale for combination hormonal therapy is to
interfere with multiple hormonal pathways to completely eliminate androgen action.

Relapse is usually after 2-4 years

Question 22

Estrogens, are they used- why or why not

Answer 22

DES was once a mainstay of prostate cancer therapy. While very effective in androgen ablation, DES-treated patients experienced increased cardiovascular mortality

Question 23

Second-line therapy for whom

Answer 23

Patients for their initial therapy has progressed

Question 24

Types of second-line therapy

Answer 24

Supportive care, chemotherapy, or local radiotherapy can be used in
patients who have failed all forms of androgen-ablation
manipulations because these patients are considered to have
androgen-independent disease.

Question 25

Whats added to Androgen for a better response

Answer 25

aminoglutethimide, at the time that androgens are withdrawn may produce a better response than androgen withdrawal alone.
Androgen synthesis inhibitors, such as aminoglutethimide and ketoconazole, can provide symptomatic relief for a short time in
approximately 50% of patients with progressive disease despite previous androgen-ablation therapy.