Prostate Cancer Flashcards
After gender-confirming surgery, can transgender women still be affected by prostate cancer?
Yes
The prostate is usually conserved after gender-confirming surgery
What are the risk factors for prostate cancer? (4)
Age (most cases being diagnosed in men over 70 years of age)
Ethnicity (black African-Caribbean men)
Obesity
Family history
Prostate cancer is usually slow-growing and asymptomatic at diagnosis. What are the presenting symptoms of advanced disease?
Urinary outflow obstructon
Pelvic or back pain (bone metastases)
What factors contribute to treatment decisions for prostate cancer?
- Baseline PSA levels
- Tumour grade (Gleason score)
- Stage of tumour
- Patient’s life expectance (based on age and comorbid conditions)
- Treatment morbidity
- Patient preference
What are the treatment options for patients with prostate cancer?
- Watchful waiting
- Active surveillance
- Prostatectomy
- Radiotherapy (such as external beam)
- Brachytherapy
- Hormone therapy
- Chemotherapy
(?) is a strategy for ‘controlling’ rather than ‘curing’ prostate cancer and is aimed at patients in whom curative treatment is unsuitable or declined. It involves monitoring for disease progression and is often suitable in patients not likely to suffer significant morbidity from their prostate cancer.
Watchful waiting
(?), a ‘curative’ strategy, is aimed at patients who do not wish to have immediate treatment for prostate cancer. It involves the deferred use of radical treatment until disease progression occurs or until the patient requests treatment.
Active surveillance
In the treatment of prostate cancer, (?) therapy includes anti-androgen therapy, androgen deprivation therapy, or a gonadorelin antagonist, and bilateral orchidectomy
hormone
What scoring system is used for tumour grade of prostate cancer?
Gleason score
What treatment choices are offered for low-risk localised prostate cancer? (3)
Active surveillance
Radical prostatectomy
Radiotherapy
What treatment choices are offered for intermediate-risk localised prostate cancer?
- Radial treatments (prostatectomy or radiotherapy)
If declined - active surveillance
What treatment choices are offered for high-risk localised prostate cancer (where there is a realistic prospect of long-term disease control) and in those with locally advanced disease? (2)
Radical prostatectomy
Radiotherapy
What should be offered in combination with radical radiotherapy in patients with intermediate-risk and high-risk localised prostate cancer?
Androgen deprivation therapy for 6 months before or after radiotherapy
High-risk localised prostate cancer - consider continuing for up to 3 years.
Brachytherapy in combination with radiotherapy can also be considered in these patients
For how long should patients with intermediate-risk and high-risk localised prostate cancer who have chosen radical radiotherapy also receive androgen deprivation therapy for?
6 months before, during or after radical radiotherapy
Consider continuing up to 3 years for high-risk localised prostate cancer
What is brachytherapy?
A type of internal radiation therapy in which seeds, ribbons or capsules that contain a radiation source are placed in your body, in or near the tumour
What chemotherapy agent is recommended for newly diagnosed non-metastatic prostate cancer if the patient is starting long-term androgen deprivation therapy, have no significant co-morbidities and have high-risk disease?
Docetaxel
Docetaxel acts by inhibiting microtubular depolymerisation
(?) with androgen deprivation therapy is recommended as a treatment option in patients with hormone-relapsed non-metastatic prostate cancer who are at high risk of developing metastatic disease
Darolutamide
Darolutamide with androgen deprivation therapy is recommended as a treatment option in patients with (?)-relapsed non-metastatic prostate cancer who are at high risk of developing metastatic disease
hormone
What chemotherapy agent should patients with newly diagnosed metastatic prostate cancer who do not have significant comorbidities receive?
Docetaxel
Docetaxel acts by inhibiting microtubular depolymerisation
What can be offered to all patients with metastatic prostate cancer as an alternative to continuous luteinising hormone-releasing hormone (LHRH) agonist treatment?
Bilateral orchidectomy
Why would you offer bicalutamide (anti-androgen monotherapy) to patients with metastatic prostate cancer who are willing to accept the adverse impact on overall survival and gynaecomastia?
Hope of retaining sexual function
However, if satisfactory sexual function is not maintained, stop bicalutamide and start androgen deprivation therapy.
What are the two recommended treatment options for hormone-relapsed metastatic prostate cancer in patients who have no or mild symptoms after andrgoen deprivation therapy has failed, and before chemotherapy is indicated?
Abiraterone acetate (in combination with prednisone or prednisolone)
Enzalutamide
Which chemotherapy agent is recommended for patients with hormone-relapsed metastatic prostate cancer?
Docetaxel
Docetaxel acts by inhibiting microtubular depolymerisation
Which bisphosphonate can be used in patients with hormone-relapsed metastatic prostate cancer to prevent or reduce skeletal-related events?
Zoledronic acid
What medication can be used to manage the side effect of hot flushes caused by long-term androgen suppression in the treatment of prostate cancer?
Medroxyprogesterone acetate (can be used for up to 10 weeks) - Ora: 20 mg once daily
Alternatives:
- cyproterone acetate (but risk of meningoma)
What should a patient being treated for prostate cancer have access to and be considered for if they experience a loss of sexual function?
Access to specialist erectile dysfunction services
Considered for treatment with a phosphodiesterase type-5 inhibitor
What should patients on androgen deprivation therapy for prostate cancer be offered to reduce fatigue and improve quality of life?
Supervised exercise program (at least twice a week for 12 weeks)
What should be offered to patients who have osteoporosis and are having androgen deprivation therapy for prostate cancer?
A bisphosphonate
Alternative: denosumab
(side effect?) can occur with long-term (longer than 6 months) bicalutamide treatment for prostate cancer
Gynaecomastia
Bicalutamide is an anti-androgen monotherapy which does not have as good survival rates, and gynaecomastia as a side effect. But patients may retain sexual function
Gynaecomastia can occur with long-term (longer than (?) months) bicalutamide treatment for prostate cancer
6 months
Bicalutamide is an anti-androgen monotherapy which does not have as good survival rates, and gynaecomastia as a side effect. But patients may retain sexual function
Gynaecomastia can occur with long-term (longer than 6 months) (?) treatment for prostate cancer
bicalutamide
Bicalutamide is an anti-androgen monotherapy which does not have as good survival rates, and gynaecomastia as a side effect. But patients may retain sexual function
When using the chemotherapy agent docetaxel, what is recommended to reduce fluid retention and hypersensitivity reactions?
Pretreatment with dexamethasone
What advice about conception and contraception should be given to WOMEN when treated with the chemotherapy agent docetaxel?
Ensure effective contraception during treatment
Men: effective contraception during treatment and for at least 6 months after stopping treatment in men
What advice about conception and contraception should be given to MEN when treated with the chemotherapy agent docetaxel?
Effective contraception during treatment and for at least 6 months after stopping treatment
Women: effective contraception during treatment
What is medroxyprogesterone acetate used for in the management of prostate cancer?
Hot flushes caused by long-term androgen suppression in men
oral
What are the common side effects of medroxyprogesterone acetate? (11 general, 11 oral use, 7 parenteral use)
Alopecia Breast abnormalities Depression Dizziness Fluid retention Insomnia Menstrual cycle irregularities Nausea Sexual dysfunction Skin reactions Weight changes
With oral use:
- Appetite increased
- Cervical abnormalities
- Constipation
- Fatigue
- Headache
- Hyperhidrosis
- Hypersensitivity
- Nervousness
- Oedema
- Tremor
- Vomiting
With parenteral use:
- Anxiety
- Asthenia
- GI discomfort
- Headaches
- Mood altered
- Pain
- Vulvovaginal infection
