Prostate Cancer ♋ Flashcards
What is prostate?
Small grand who’s growth controlled by testosterone
Epidemiology
Most diagnosed cancer in AUS
Risk Factors for prostate cancer
1 age
2 family history
3 genetics
4 ethnicity
5 lifestyle > diet = high fats , red meat, low fruit and veg
Symptoms are rare
What symptoms show in advanced PC
- frequent or sudden need to urinate
- difficulty urinating
- blood in urine
- pain in lower back, pelvis, hips, upper thighs
- unexplained weight loss
Diagnosis of PROSTATE CANCER
- Physical exam
- Prostate specific antigen
- Prostate biopsy = definitive
- Gleason score
What is PSA
PROSTATE SPECIFIC ANTIGEN??
- Produced by both non-malignant and malignant epithelial cells
- Prostate specific, not prostate CANCER specific
May increase from prostatitis and BPH
What is Gleason score?
Determines how aggressive the PC will behave.
Higher the number, higher grade of tumor
Radiotherapy
What is Brachytherapy?
Implant of radioactive seeds, minimal exposure to surrounding tissues.
Treatment options?
- Active surveillance
- Surgery
- Radiotherapy
- Hormone therapy or androgen deprivation therapy (ADT)
- Chemo
Treatment for ADVANCED PROSTATE CANCER
- ADT is standard
Androgen deprivation therapy
What hypothalmic hormone found in PROSTATE CANCER
GnRH
Gonadotropin Releasing Hormone
How is testosterone produced in the hypothalmic-pituitary- Endocrine axis?
- GNRH binds Receptors in pituitary
- Increased pituitary hormones = FSH and LH
- FSH & LH activate receptors at Endocrine tissues
- Get synthesis of TESTOSTERONE
What does GNRH control?
Release of Follicle Stimualting Hormone (FSH) and Lutienising Hormone (LH)
In men, what does LH act on?
Acts on testicular leydig cells to stimulate de Novo synthesis of androgens (testosterone) from cholesterol
What are the 3 gonadal steroids?
Androgens, oestrogen abd progesterone
Name 3 GNRH agonsits
Goserelin
Leuprorelin
Triptorelin
Name GNRH Antagonist 1
Degarelix
Name anti androgens
Drug names 2
Bicalutamide
Enzalutamide
Name a steroid synthesis inhibitor 1
Abiraterone
CYP17 inhibitor
Action of GNRH agonist?
Initially stimulates synthesis of FSH and LH = INCREASING SERUM TESTOSTERONE
continuous administration =
Downregulayes GNRH Receptor = inhibiting gonadotropin production = suppressing testicular steroidogenesis
Causes tumour flare!
Action of GNRH Antagonist
Competitively and reversibly blocks and ANTAGONISES GNRH receptors
Decreases LH production, which lowers testosterone production in testes.
Lowers testosterone and PSA more quickly.
Action of ANTI ANDROGENS
Competitively inhibit binding of androgens at the androgen Receptor.
Do ANTI ANDROGEN DRUGS disrupt production of androgen?
No, only disrupts it’s binding to the Receptor and the down streams Effects of this
Indication of use
Anti androgens
- 1st line hormonal therapy
Add on therapy with orchiectomy or GNRH agonist - prevents tumour flares
- castrate resistant prostate cancer
- metastatic snd non metastatic pc
Steroid synthesis inhibitor
INDICATIONS OF USE
- high risk, resistant advanced prostate cancer
IN combination with
PREDNISONE
Steroid synthesis inhibitor
action
Abitaterone inhibits CYP17, REDUCING synthesis in testicular, adrenal and prostate tumour tissues.
Also lowers other hormones = cortisol
Which class of drugs has an
Osteoporosis risk
All (GNRH agonist and Antagonist, steroid synthesis inhibitors)
except,
Anti androgens
Which drug class causes
Mineralicorticoid effects
(Inc BP, HYPOK, FLUID RETENTION)
Steroid synthesis Inhibitors
What effect does
ANDROGEN DEPRIVATION THERAPY
Have on bone?
ADT reduces serum testosterone concentration =
Increased bone loss and fracture risk
** ensure adequate calcium and vit d
