Prostate Cancer Flashcards
What is the epidemiology of Prostate Cancer?
- MOST common in males
- 2nd MOST deadly in males
What is the main cause of Prostate Cancer?
- Mainly a hormonal thing, too much TESTOSTERONE increasing prostate size & alterations to ANDROGEN receptors
What are some of the risk factors for Prostate Cancer?
- Age: > 60y [increased testosterone]
- Race: More in AA & less in Asian
- Family Hx:
- Diet
- Vasectomy
When Prostate Cancer occurs, what are some of the main side effects?
- More urination, cant start or stop, hematuria, cant empty bladder, edema, importance
What is the histology of Prostate Cancer?
- PSA level [check]
- CT/MRI if metastatic [bone, chest, abdomen…]
- ADENOCARCINOMA
- VERY slow growth
- Metastases to the BONE, liver, lungs
What is the way that we grade Prostate Cancer?
- Gleason Score [2-10]: how fast is grows
- 2-4: slow growing = lower risk
- 8-10: fast growth = higher risk
What do the treatments depend on [how to pick the best one] in Prostate Cancer?
- Stage, Score [Gleason], Age, Healthy, Personal
What are some of the common stages for Prostate Cancer?
- Localized [not progressed]
- Metastatic [m0 & m1]
What are some of the treatment strategies for Localized Prostate Cancer?
- Observation, Active Surveillance, Radiation, Surgery
What is involved in the Observation Treatment for Prostate Cancer?
- Monitoring with possibly palliative therapy [pain meds or xrt] for symptoms or change in PSA
- Avoids morbidity BUT causes complications
What is involved in the Active Surveillance Treatment for Prostate Cancer?
- Prostate is benign –> use curative therapy
- 2/3 avoid therapy [avoids SE] BUT 1/3 may need therapy
What is involved in Radiation Therapy Treatment in Prostate Cancer?
- Beam or Brachytherapy [inplantable]
- NOT surgical candidates
- May cause; bladder issues, ED, Raiation Proctitis
- Low to Mod risk = adjuvant ADT
What is involved in Surgery in Prostate Cancer?
- DEFINITIVE cure –> survival 85%
- May cause impotence
What is Androgen Deprivation Therapy in Prostate Cancer?
- GOAL: induce castrate levels of Testosterone
- Can remove testes [NO]; use LHRH
- ADT = LHRH + anti-androgen or surgery
What are some of the Metastatic Diseases in Prostate Cancer?
- M0HSPC
- M0CRPC
- M1HSPC [low or high]
- M1CRPC
What is the general goal of Metastatic Disease in Prostate Cancer?
- GOAL: Palliation of disease
- Reduce testosterone [+90% in made in testes]
- Want to find doubling time
What is Metastatic Disease M0HSPC in Prostate Cancer?
- Not metastatic yet - takes hormone therapy
- ONLY PSA recurrence –> Delay ADT
- Rapid PSA or ShorPSA doubling time –> ADT [Double < 6m = ADT; Double > 6m = observe]
What are some of the way that we can treat Metastatic Disease M0HSPC in Prostate Cancer?
- Removal of testes [IMMEDIATE drops testosterone] & LHRH agonist [Leuprolide or Goserelin]
What is important to know within the LHRH Agonists for Prostate Cancer?
- Leuprolide is IM; Goserelin is SQ
- Cause that HUGE surge, stoping testosterone
What are some fo the Toxicities for LHRH Agonists for Prostate Cancer?
- Tumor Flare [surge], gynecomastia, hot flashes
- Osteoporosis [put on Ca+VitD]
What is the difference between the LHRH Agonists and Relugolix?
- LHRH = Injection
- Relugolix = Oral [less cardio events]
What is the way that we are able to minimize the risk of flare ups from LHRH Agonists in Prostate Cancer>
- Give Anti-androgens 1 week prior
What are the Anti-Androgens used to help reduce that Flare Up from the LHRH Agonists?
- Bicalutamide [most common; diarrhea]
- Flutamide, Nilutamide
What is Intermittent ADT in M0HSPC in Prostate Cancer?
- PSA levels returning to a baseline, can stop androgen suppression
- Men with biochemical failure ONLY
What is M0CRPC in Prostate Cancer?
- PSA is increasing & NOT responding to ADT with NO metastases
- ADT [LHRH] + “lutamide”
- NO Abiraterone in M0`
Should Abiraterone be used in a M0 setting?
- NO
What is the importance about Enzalutamide in Prostate Cancer?
- Blocks androgen binding
- Avoid CYP2C8, 3A4, 2C9, 2C19…
- Decrease Warfarin
- Seizures
- ONCE daily
What is important to know about Apalutamide in Prostate Cancer?
- Decreases tumor proliferation and increases apoptosis
- Metabolized CYP3A4, 2C8
- Seizures, QTc Prolongation,
- ONCE daily
What is important to know about Darolutamide in Prostate Cancer?
- Less toxic [less fractures, falls, seizures, weight loss]
- Metabolized CYP3A4
- TWICE daily
Out of the three “lutamides” which is the best one to use?
- DAROLUTAMIDE
What is M1HSPC in Prostate Cancer?
- is now METASTATIC
- Therapy is based on volume [low or high]
What is the treatment for Low Volume M1HSPC in Prostate Cancer?
- ADT [LHRH Agonist or Antagonist]
- Abiraterone + Prednisone OR Enzalutamide OR Apalutamide
What is the importance about Abiraterone in Prostate Cancer?
- IRREVERSIBLY inhibits CYP17 stoping testorterone precursors
- NEED Prednisone to prevent adrenal insufficiency
What are some of the toxicities for Abiraterone in Prostate Cancer?
- Hypertension, Edema, Hot Flashes
- NEED daily prednisone
What are the treatment options for High Volume M1HSPC in Prostate Cancer?
- ADT
- ADT + Abiraterone + Prednisone
- ADT + Enzalutamide
- ADT + Apalutamide
- CHEMO?!?!?
What is the Chemotherapy that is used in M1HSPC in Prostate Cancer?
- Docetaxel + ADT = 1st line [CHARRTED Trail]
When is Chemo + ADT mainly used in Prostate Cancer?
- Visceral Metastases [lungs, liver, adrenal…], Bone Metas, One metastases in pelvis
What does the newer data show for High Volume, Castrate Sensitive, Metastatic Disease in Prostate Cancer?
- USE ALL
- ADT + Docetaxel + Darolutamide
- ADT + Docetaxel + Abiraterone + Prednisone
What is M1CRPC in Prostate Cancer?
- Metastatic Castrate Recurrent Prostate Cancer –> cancer continues with low testoserone
- Continue ADT to maintain castrate testosterone levels
What are some of the treatment options for M1CRPC in Prostate Cancer?
- Sipuleucel-T [CAR-T]
- Docetaxel [1st line - alone or with…]
- Cabazitaxel [2nd line]
- Radium-223 [bone metas]
- Abiraterone + Predinisone
- Enzalutamide
What is important to know about Cabazitaxel in Prostate Cancer?
- 2nd Line
- Binds to tublin promoting assembly
- Unlike other taxanes?
- More severe toxicites
What are some of the chemotherapy options for Metastatic Disease in M1CSPC?
- Docetaxel + Prednisone
- Cabazitaxel + Prednisone
- Mitoxantrone + prednisone
What is the ONLY medication that is used in Bone Metastases in Prostate Cancer?
- Radium-223
How does Radium 223 work within Prostate Cancer?
- Emits high energy to the bone metastases causing it to radiate and get destroyed
- Used in CRPC
- LOTS of myelosuppression
