Prostate Cancer Flashcards
What is the key enzyme involved in biosynthesis of testosterone?
CYP17A1
List the risk factors for prostate cancer. (3)
age > 60; african-american; family history
What are the two screening modalities used for prostate cancer?
Digital rectal exam (DRE) & prostate specific antigen (PSA)
What PSA level is highly suspicious for malignancy?
> 10 ng/mL
What PSA velocity is highly suspicious for malignancy?
> 0.75 ng/mL increase over the course of a year
At what age should men begin annual prostate screenings?
50
How do most patients with prostate cancer present?
asymptomatic
Where does prostate cancer metasasize to? (3)
bone (most common); lung; liver
A high gleason score signifies ______.
more poorly differentiated tumor with higher risk of recurrence
What are the treatment options for localized prostate cancer? (4)
observation; active surveillance; radiation therapy; prostatectomy
What does observation entail? Is the therapy palliative or curative?
monitor PSA and DRE every 6 months; palliative therapy
What does active surveillance entail? Is the therapy palliative or curative?
monitor PSA, DRE, & symptoms; curative therapy
What is external beam radiation?
radiation from the outside coming in
What is brachytherapy radiation?
a radiation implant that is placed near the prostate
In what patient population would you recommend radiation therapy?
patients with a high Gleason score (higher risk of recurrence)
What are the guidelines for ADT in patients getting radiation therapy?
start ADT prior to radiation therapy, then continue during and for 1-3 years after
What is the only definitive curative surgery for prostate cancer?
radical prostatectomy
When would you initiate ADT in M0-HSPC?
if PSA doubling time is less than 6 months
What surgical procedure can be done in M0-HSPC?
orchiectomy (removal of testes)
What are the LHRH agonists? (4)
leuprolide; goserelin; triptorelin; hiterelin
List the acute toxicities of LHRH antagonists. (5)
tumor flare; gynecomastia; hot flashes; erectile dysfunction; edema
List the two main chronic toxicities of LHRH antagonists.
osteoporosis; cardiovascular events
Definition: toxicity that occurs in metastatic patients where their symptoms worsen during initial treatment with LHRH agonist
tumor flare
What can be administered during the first week of LHRH agonist treatment to prevent tumor flare?
an anti-androgen
How does intermittent ADT work?
PSA is constantly monitored; ADT is discontinued once PSA drops to desired baseline; ADT is restarted at a pre-defined PSA level
What is the advantage of intermittent ADT? (2)
decreased cost; decreased side effects
What is the LHRH antagonist?
degarelix
Does tumor flare occur with LHRH antagnonists?
no
How long does it take to see the drop in testosterone with LHRH antagonists?
7 days
What therapy is included in an M0CRPC regimen?
LHRH agonist + anti-androgen
What are the anti-androgen options? (3)
enzalutamide; apalutamide; darolutamide
What drug should not be given with enzalutamide?
prednisone
What are two main toxicities of enzalutamide?
seizures; enzalutamide syndrome
What is enzalutamide syndrome? (3)
foggy; unclear thinking; fatigue
What are two main toxicities of apalutamide?
seizures; QT prolongation
What is a benefit of using darolutamide?
less toxicities
What regimen is used in low volume M1HSPC?
LHRH antagonists; abiraterone + prednisone
Why must abiraterone be administered with prednisone?
to prevent renal insufficiency
How does abiraterone work?
it selectively and irreversibly inhibits CYP17
What regimen is used in high volume M1HSPC?
docetaxel + ADT
What is first line for M1CRPC?
docetaxel + prednisode
What is second line for M1CRPC?
cabazitaxel + prednisone
What is used to treat bone metastases?
radium 223 chloride
How does radium 223 chloride work?
it forms complexes with bone mineral in areas with increased bone turnover, leading to DNA strand breaks and an antitumor effect on bone mets
What drugs are used for palliation of pain due to bone mets? (2)
bisphosphonates; RANK-L inhibitors
What drug is used for cancers which express dMMR or MSI-H characteristics?
pembrolizumab
