Prostate Cancer Flashcards
What is the median age of prostate cancer diagnosis?
72
What is the most commonly diagnosed cancer in men?
prostate cancer
Prostate cancer is the ______ leading cause of death in men
2nd
What is true about number of cases vs. number of deaths of prostate cancer?
number of cases outweighs number of deaths; high survival rate
What is the cause of prostate cancer?
Hormonal (increased testosterone increases risk of prostate cancer)
Genetic (family hx, gene mutation)
What are risk factors for prostate cancer?
Older age
Race (AA > white> asaian)
First degree relative
BPH
Increased testosterone exposure (supplementation)
What is a possible risk factor for prostate cancer?
high fat diet
What factors are not associated with prostate cancer?
Smoking
Alcohol
Occupation
What can be used to prevent prostate cancer?
No strong data for preventative measures
What was found in studies that used Finasteride to prevent prostate cancer?
- reduced prevalence by 24%
- those who did get prostate cancer had a more aggressive form when taking Finasteride
How can prostate cancer be screened?
Digital Rectal Exam (DRE)
Prostate Specific Antigen (PSA)
Transrectal ultrasonography
What are the pros of a Digital Rectal Exam?
Specificity >85%, low cost
What are the cons of Digital Rectal Exam?
poor compliance, relatively insensitive
What Prostate Specific Antigen value indicates increased risk of prostate cancer or BPH?
> 4
When would a transrectal ultrasonography be indicated?
when DRE or PSA come back abnormal
What PSA value would indicate progression of prostate cancer or BPH?
PSA doubling time
When would annual screening be appropriate?
men > 50 years old
When would screening not be appropriate anymore?
life expectancy < 10 years
When would screening start at 45 years old?
African American
Family History
What stage of PC is asymptomatic?
early stage localized disease
When would someone start to experience alterations in urination and impotence?
locally invasive disease
What symptoms would indicate advanced metastatic disease?
Lower extremity edema
Hematuria/ blood in semen
Bone pain (back/leg) or fractures
Anemia
Weight loss
What are the most common metastatic sites of PC?
Bone (80%)
Lung
Liver
What does the “T” stand for when staging?
size of tumor
What does the “N” stand for when staging?
invades lymph nodes in the pelvis
What does the “M” stand for when staging?
metastasis
What is the Gleason score based on?
biopsy of both sides of the prostate
How is the Gleason score calculated?
(1-5) on one side + (1-5) on the other side
What does a Gleason grade of 1 indicate?
that side of the cancerous prostate closely resembles the normal prostate
What does a Gleason grade of 5 indicate?
that side of the cancerous prostate does NOT resemble normal prostate
What type of PC is curable?
localized disease (T1 and T2)
What type of PC is palliative?
advanced disease/ metastasis
What are treatment options for stage 1 or 2?
Active surveillance
Radical prostatectomy (RP)
Radiation therapy (RT)
When is active surveillance a good option?
< 10 years life expectancy
Low grade disease
Cancer is benign and indolent
What is monitored during active surveillance?
PSA, DRE, and symptoms
Although radical prostatectomy is highly curative, what are the complications associated?
Early mortality
Bladder contracture
Incontinence
Impotence
What are the complications with radiation?
Impotence
Rectal/ bladder symptoms
What are treatment options for locally advanced disease (stage 3)?
Radiation +/- ADT
ADT
What are 1st line pharmacotherapies for PC?
Androgen ablation (orchiectomy; LHRH agonists)
Combined Androgen Blockade (LHRH agonist + anti androgen)
What is the MOA of LHRH agonists?
- surge of LHRH increases LH and ACTH production
- negative feedback loop eventually shuts down LH and ACTH production
What is given for 7 days to suppress LH/ACTH flare?
antiandrogen
What are the adverse events of androgen ablation?
Hot flashes
Erectile impotence
Decreased libido
Metabolic complications
Cardiovascular Disease
Osteoporosis
What is the MOA of antiandrogens?
inhibits androgen uptake/ binding of androgens in target tissues
What is considered hormone refractory?
serum testosterone < 50 ng/dL and disease progression
What anti-androgen combination treatment is indicated for metastatic castration-resistant prostate cancer (CRPC)?
Abiraterone + Prednisone
What is the MOA of Abiraterone?
- Selectively and irreversibly inhibits CYP17, enzyme is required for androgen biosynthesis expressed in testicular, adrenal, and prostate tumor tissues
- inhibits the formation of testosterone precursors DHEA and androstenedione
What are adverse events with Abiraterone?
Fluid retention
Edema
Hypokalemia
LFT elevation
What is the MOA if androgen receptor inhibitor?
acts on multiple steps of the androgen receptor signaling pathway within the tumor cell
1. inhibits androgen from binding to receptor
2. inhibits androgen receptor from entering the cell nucleus
3. inhibits androgen receptor binding to DNA
What is a pro of using androgen receptor inhibitors?
DO NOT need concurrent prednisone
What are side effects of androgen recptor inhibitors?
Muscle aches
Fatigue
HTN
Possible incidence of seizures
What drug class would you not use for history of seizures?
Androgen receptor inhibitors
What chemotherapy is used for PC?
Docetaxel
What is the MOA of Docetaxel?
inhibits depolymerization of tubulin, stabilizing microtubules in cells, and inhibiting mitosis
What are adverse reactions with Docetaxel?
Neuropathy
Alopecia
Myelosuppression
Hypersensitivity reactions
What are treatments of metastatic disease (stage 4)?
1st line: ADT
2nd line: secondary hormonal therapy
3rd line: chemotherapy
What drugs prevent skeletal-related problems?
Zoledronic Acid
Denosumab
What is the MOA of Zolendronic Acid?
inhibits osteoclast function
What is the MOA of Denosumab?
RANK ligand inhibitor; inhibits both the production and function of osteoclast
What are adverse events with Zolendronic Acid?
Renal insufficiency
Hypocalcemia
Osteonecrosis of the jaw
What are adverse events with Denosumab?
Hypocalcemia
Osteonecrosis of the jaw
When is an agent for preventing skeletal-related complications given?
All patients who receive ADT or who have metastatic disease
