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Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

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1
Q

After gender-confirming surgery, can transgender women still be affected by prostate cancer?

A

Yes

The prostate is usually conserved after gender-confirming surgery

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2
Q

What are the risk factors for prostate cancer? (4)

A

Age (most cases being diagnosed in men over 70 years of age)
Ethnicity (black African-Caribbean men)
Obesity
Family history

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3
Q

Prostate cancer is usually slow-growing and asymptomatic at diagnosis. What are the presenting symptoms of advanced disease?

A

Urinary outflow obstructon

Pelvic or back pain (bone metastases)

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4
Q

What factors contribute to treatment decisions for prostate cancer?

A
  1. Baseline PSA levels
  2. Tumour grade (Gleason score)
  3. Stage of tumour
  4. Patient’s life expectance (based on age and comorbid conditions)
  5. Treatment morbidity
  6. Patient preference
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5
Q

What are the treatment options for patients with prostate cancer?

A
  1. Watchful waiting
  2. Active surveillance
  3. Prostatectomy
  4. Radiotherapy (such as external beam)
  5. Brachytherapy
  6. Hormone therapy
  7. Chemotherapy
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6
Q

(?) 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.

A

Watchful waiting

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7
Q

(?), 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.

A

Active surveillance

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8
Q

In the treatment of prostate cancer, (?) therapy includes anti-androgen therapy, androgen deprivation therapy, or a gonadorelin antagonist, and bilateral orchidectomy

A

hormone

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9
Q

What scoring system is used for tumour grade of prostate cancer?

A

Gleason score

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10
Q

What treatment choices are offered for low-risk localised prostate cancer? (3)

A

Active surveillance
Radical prostatectomy
Radiotherapy

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11
Q

What treatment choices are offered for intermediate-risk localised prostate cancer?

A
  1. Radial treatments (prostatectomy or radiotherapy)

If declined - active surveillance

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12
Q

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)

A

Radical prostatectomy

Radiotherapy

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13
Q

What should be offered in combination with radical radiotherapy in patients with intermediate-risk and high-risk localised prostate cancer?

A

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

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14
Q

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?

A

6 months before, during or after radical radiotherapy

Consider continuing up to 3 years for high-risk localised prostate cancer

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15
Q

What is brachytherapy?

A

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

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16
Q

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?

A

Docetaxel

Docetaxel acts by inhibiting microtubular depolymerisation

17
Q

(?) 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

A

Darolutamide

18
Q

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

A

hormone

19
Q

What chemotherapy agent should patients with newly diagnosed metastatic prostate cancer who do not have significant comorbidities receive?

A

Docetaxel

Docetaxel acts by inhibiting microtubular depolymerisation

20
Q

What can be offered to all patients with metastatic prostate cancer as an alternative to continuous luteinising hormone-releasing hormone (LHRH) agonist treatment?

A

Bilateral orchidectomy

21
Q

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?

A

Hope of retaining sexual function

However, if satisfactory sexual function is not maintained, stop bicalutamide and start androgen deprivation therapy.

22
Q

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?

A

Abiraterone acetate (in combination with prednisone or prednisolone)

Enzalutamide

23
Q

Which chemotherapy agent is recommended for patients with hormone-relapsed metastatic prostate cancer?

A

Docetaxel

Docetaxel acts by inhibiting microtubular depolymerisation

24
Q

Which bisphosphonate can be used in patients with hormone-relapsed metastatic prostate cancer to prevent or reduce skeletal-related events?

A

Zoledronic acid

25
Q

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?

A 
Medroxyprogesterone acetate (can be used for up to 10 weeks) 
- Ora: 20 mg once daily

Alternatives:
- cyproterone acetate (but risk of meningoma)

26
Q

What should a patient being treated for prostate cancer have access to and be considered for if they experience a loss of sexual function?

A

Access to specialist erectile dysfunction services

Considered for treatment with a phosphodiesterase type-5 inhibitor

27
Q

What should patients on androgen deprivation therapy for prostate cancer be offered to reduce fatigue and improve quality of life?

A

Supervised exercise program (at least twice a week for 12 weeks)

28
Q

What should be offered to patients who have osteoporosis and are having androgen deprivation therapy for prostate cancer?

A

A bisphosphonate

Alternative: denosumab

29
Q

(side effect?) can occur with long-term (longer than 6 months) bicalutamide treatment for prostate cancer

A

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

30
Q

Gynaecomastia can occur with long-term (longer than (?) months) bicalutamide treatment for prostate cancer

A

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

31
Q

Gynaecomastia can occur with long-term (longer than 6 months) (?) treatment for prostate cancer

A

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

32
Q

When using the chemotherapy agent docetaxel, what is recommended to reduce fluid retention and hypersensitivity reactions?

A

Pretreatment with dexamethasone

33
Q

What advice about conception and contraception should be given to WOMEN when treated with the chemotherapy agent docetaxel?

A

Ensure effective contraception during treatment

Men: effective contraception during treatment and for at least 6 months after stopping treatment in men

34
Q

What advice about conception and contraception should be given to MEN when treated with the chemotherapy agent docetaxel?

A

Effective contraception during treatment and for at least 6 months after stopping treatment

Women: effective contraception during treatment

35
Q

What is medroxyprogesterone acetate used for in the management of prostate cancer?

A

Hot flushes caused by long-term androgen suppression in men

oral

36
Q

What are the common side effects of medroxyprogesterone acetate? (11 general, 11 oral use, 7 parenteral use)

A 
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

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology (27 decks)

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