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Therapeutics IV > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What is the key enzyme involved in biosynthesis of testosterone?

A

CYP17A1

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2
Q

List the risk factors for prostate cancer. (3)

A

age > 60; african-american; family history

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3
Q

What are the two screening modalities used for prostate cancer?

A

Digital rectal exam (DRE) & prostate specific antigen (PSA)

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4
Q

What PSA level is highly suspicious for malignancy?

A

> 10 ng/mL

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5
Q

What PSA velocity is highly suspicious for malignancy?

A

> 0.75 ng/mL increase over the course of a year

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6
Q

At what age should men begin annual prostate screenings?

A

50

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7
Q

How do most patients with prostate cancer present?

A

asymptomatic

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8
Q

Where does prostate cancer metasasize to? (3)

A

bone (most common); lung; liver

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9
Q

A high gleason score signifies ______.

A

more poorly differentiated tumor with higher risk of recurrence

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10
Q

What are the treatment options for localized prostate cancer? (4)

A

observation; active surveillance; radiation therapy; prostatectomy

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11
Q

What does observation entail? Is the therapy palliative or curative?

A

monitor PSA and DRE every 6 months; palliative therapy

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12
Q

What does active surveillance entail? Is the therapy palliative or curative?

A

monitor PSA, DRE, & symptoms; curative therapy

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13
Q

What is external beam radiation?

A

radiation from the outside coming in

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14
Q

What is brachytherapy radiation?

A

a radiation implant that is placed near the prostate

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15
Q

In what patient population would you recommend radiation therapy?

A

patients with a high Gleason score (higher risk of recurrence)

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16
Q

What are the guidelines for ADT in patients getting radiation therapy?

A

start ADT prior to radiation therapy, then continue during and for 1-3 years after

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17
Q

What is the only definitive curative surgery for prostate cancer?

A

radical prostatectomy

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18
Q

When would you initiate ADT in M0-HSPC?

A

if PSA doubling time is less than 6 months

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19
Q

What surgical procedure can be done in M0-HSPC?

A

orchiectomy (removal of testes)

20
Q

What are the LHRH agonists? (4)

A

leuprolide; goserelin; triptorelin; hiterelin

21
Q

List the acute toxicities of LHRH antagonists. (5)

A

tumor flare; gynecomastia; hot flashes; erectile dysfunction; edema

22
Q

List the two main chronic toxicities of LHRH antagonists.

A

osteoporosis; cardiovascular events

23
Q

Definition: toxicity that occurs in metastatic patients where their symptoms worsen during initial treatment with LHRH agonist

A

tumor flare

24
Q

What can be administered during the first week of LHRH agonist treatment to prevent tumor flare?

A

an anti-androgen

25
Q

How does intermittent ADT work?

A

PSA is constantly monitored; ADT is discontinued once PSA drops to desired baseline; ADT is restarted at a pre-defined PSA level

26
Q

What is the advantage of intermittent ADT? (2)

A

decreased cost; decreased side effects

27
Q

What is the LHRH antagonist?

A

degarelix

28
Q

Does tumor flare occur with LHRH antagnonists?

A

no

29
Q

How long does it take to see the drop in testosterone with LHRH antagonists?

A

7 days

30
Q

What therapy is included in an M0CRPC regimen?

A

LHRH agonist + anti-androgen

31
Q

What are the anti-androgen options? (3)

A

enzalutamide; apalutamide; darolutamide

32
Q

What drug should not be given with enzalutamide?

A

prednisone

33
Q

What are two main toxicities of enzalutamide?

A

seizures; enzalutamide syndrome

34
Q

What is enzalutamide syndrome? (3)

A

foggy; unclear thinking; fatigue

35
Q

What are two main toxicities of apalutamide?

A

seizures; QT prolongation

36
Q

What is a benefit of using darolutamide?

A

less toxicities

37
Q

What regimen is used in low volume M1HSPC?

A

LHRH antagonists; abiraterone + prednisone

38
Q

Why must abiraterone be administered with prednisone?

A

to prevent renal insufficiency

39
Q

How does abiraterone work?

A

it selectively and irreversibly inhibits CYP17

40
Q

What regimen is used in high volume M1HSPC?

A

docetaxel + ADT

41
Q

What is first line for M1CRPC?

A

docetaxel + prednisode

42
Q

What is second line for M1CRPC?

A

cabazitaxel + prednisone

43
Q

What is used to treat bone metastases?

A

radium 223 chloride

44
Q

How does radium 223 chloride work?

A

it forms complexes with bone mineral in areas with increased bone turnover, leading to DNA strand breaks and an antitumor effect on bone mets

45
Q

What drugs are used for palliation of pain due to bone mets? (2)

A

bisphosphonates; RANK-L inhibitors

46
Q

What drug is used for cancers which express dMMR or MSI-H characteristics?

A

pembrolizumab

Therapeutics IV (21 decks)

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