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PHRM 864: Therapeutics IV > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What is the epidemiology of Prostate Cancer?

A
  • MOST common in males
  • 2nd MOST deadly in males
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2
Q

What is the main cause of Prostate Cancer?

A
  • Mainly a hormonal thing, too much TESTOSTERONE increasing prostate size & alterations to ANDROGEN receptors
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3
Q

What are some of the risk factors for Prostate Cancer?

A
  • Age: > 60y [increased testosterone]
  • Race: More in AA & less in Asian
  • Family Hx:
  • Diet
  • Vasectomy
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4
Q

When Prostate Cancer occurs, what are some of the main side effects?

A
  • More urination, cant start or stop, hematuria, cant empty bladder, edema, importance
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5
Q

What is the histology of Prostate Cancer?

A
  • PSA level [check]
  • CT/MRI if metastatic [bone, chest, abdomen…]
  • ADENOCARCINOMA
  • VERY slow growth
  • Metastases to the BONE, liver, lungs
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6
Q

What is the way that we grade Prostate Cancer?

A
  • Gleason Score [2-10]: how fast is grows
  • 2-4: slow growing = lower risk
  • 8-10: fast growth = higher risk
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7
Q

What do the treatments depend on [how to pick the best one] in Prostate Cancer?

A
  • Stage, Score [Gleason], Age, Healthy, Personal
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8
Q

What are some of the common stages for Prostate Cancer?

A
  • Localized [not progressed]
  • Metastatic [m0 & m1]
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9
Q

What are some of the treatment strategies for Localized Prostate Cancer?

A
  • Observation, Active Surveillance, Radiation, Surgery
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10
Q

What is involved in the Observation Treatment for Prostate Cancer?

A
  • Monitoring with possibly palliative therapy [pain meds or xrt] for symptoms or change in PSA
  • Avoids morbidity BUT causes complications
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11
Q

What is involved in the Active Surveillance Treatment for Prostate Cancer?

A
  • Prostate is benign –> use curative therapy
  • 2/3 avoid therapy [avoids SE] BUT 1/3 may need therapy
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12
Q

What is involved in Radiation Therapy Treatment in Prostate Cancer?

A
  • Beam or Brachytherapy [inplantable]
  • NOT surgical candidates
  • May cause; bladder issues, ED, Raiation Proctitis
  • Low to Mod risk = adjuvant ADT
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13
Q

What is involved in Surgery in Prostate Cancer?

A
  • DEFINITIVE cure –> survival 85%
  • May cause impotence
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14
Q

What is Androgen Deprivation Therapy in Prostate Cancer?

A
  • GOAL: induce castrate levels of Testosterone
  • Can remove testes [NO]; use LHRH
  • ADT = LHRH + anti-androgen or surgery
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15
Q

What are some of the Metastatic Diseases in Prostate Cancer?

A
  • M0HSPC
  • M0CRPC
  • M1HSPC [low or high]
  • M1CRPC
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16
Q

What is the general goal of Metastatic Disease in Prostate Cancer?

A
  • GOAL: Palliation of disease
  • Reduce testosterone [+90% in made in testes]
  • Want to find doubling time
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17
Q

What is Metastatic Disease M0HSPC in Prostate Cancer?

A
  • Not metastatic yet - takes hormone therapy
  • ONLY PSA recurrence –> Delay ADT
  • Rapid PSA or ShorPSA doubling time –> ADT [Double < 6m = ADT; Double > 6m = observe]
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18
Q

What are some of the way that we can treat Metastatic Disease M0HSPC in Prostate Cancer?

A
  • Removal of testes [IMMEDIATE drops testosterone] & LHRH agonist [Leuprolide or Goserelin]
19
Q

What is important to know within the LHRH Agonists for Prostate Cancer?

A
  • Leuprolide is IM; Goserelin is SQ
  • Cause that HUGE surge, stoping testosterone
20
Q

What are some fo the Toxicities for LHRH Agonists for Prostate Cancer?

A
  • Tumor Flare [surge], gynecomastia, hot flashes
  • Osteoporosis [put on Ca+VitD]
21
Q

What is the difference between the LHRH Agonists and Relugolix?

A
  • LHRH = Injection
  • Relugolix = Oral [less cardio events]
22
Q

What is the way that we are able to minimize the risk of flare ups from LHRH Agonists in Prostate Cancer>

A
  • Give Anti-androgens 1 week prior
23
Q

What are the Anti-Androgens used to help reduce that Flare Up from the LHRH Agonists?

A
  • Bicalutamide [most common; diarrhea]
  • Flutamide, Nilutamide
24
Q

What is Intermittent ADT in M0HSPC in Prostate Cancer?

A
  • PSA levels returning to a baseline, can stop androgen suppression
  • Men with biochemical failure ONLY
25
Q

What is M0CRPC in Prostate Cancer?

A
  • PSA is increasing & NOT responding to ADT with NO metastases
  • ADT [LHRH] + “lutamide”
  • NO Abiraterone in M0`
26
Q

Should Abiraterone be used in a M0 setting?

A
  • NO
27
Q

What is the importance about Enzalutamide in Prostate Cancer?

A
  • Blocks androgen binding
  • Avoid CYP2C8, 3A4, 2C9, 2C19…
  • Decrease Warfarin
  • Seizures
  • ONCE daily
28
Q

What is important to know about Apalutamide in Prostate Cancer?

A
  • Decreases tumor proliferation and increases apoptosis
  • Metabolized CYP3A4, 2C8
  • Seizures, QTc Prolongation,
  • ONCE daily
29
Q

What is important to know about Darolutamide in Prostate Cancer?

A
  • Less toxic [less fractures, falls, seizures, weight loss]
  • Metabolized CYP3A4
  • TWICE daily
30
Q

Out of the three “lutamides” which is the best one to use?

A
  • DAROLUTAMIDE
31
Q

What is M1HSPC in Prostate Cancer?

A
  • is now METASTATIC
  • Therapy is based on volume [low or high]
32
Q

What is the treatment for Low Volume M1HSPC in Prostate Cancer?

A
  • ADT [LHRH Agonist or Antagonist]
  • Abiraterone + Prednisone OR Enzalutamide OR Apalutamide
33
Q

What is the importance about Abiraterone in Prostate Cancer?

A
  • IRREVERSIBLY inhibits CYP17 stoping testorterone precursors
  • NEED Prednisone to prevent adrenal insufficiency
34
Q

What are some of the toxicities for Abiraterone in Prostate Cancer?

A
  • Hypertension, Edema, Hot Flashes
  • NEED daily prednisone
35
Q

What are the treatment options for High Volume M1HSPC in Prostate Cancer?

A
  • ADT
  • ADT + Abiraterone + Prednisone
  • ADT + Enzalutamide
  • ADT + Apalutamide
  • CHEMO?!?!?
36
Q

What is the Chemotherapy that is used in M1HSPC in Prostate Cancer?

A
  • Docetaxel + ADT = 1st line [CHARRTED Trail]
37
Q

When is Chemo + ADT mainly used in Prostate Cancer?

A
  • Visceral Metastases [lungs, liver, adrenal…], Bone Metas, One metastases in pelvis
38
Q

What does the newer data show for High Volume, Castrate Sensitive, Metastatic Disease in Prostate Cancer?

A
  • USE ALL
  • ADT + Docetaxel + Darolutamide
  • ADT + Docetaxel + Abiraterone + Prednisone
39
Q

What is M1CRPC in Prostate Cancer?

A
  • Metastatic Castrate Recurrent Prostate Cancer –> cancer continues with low testoserone
  • Continue ADT to maintain castrate testosterone levels
40
Q

What are some of the treatment options for M1CRPC in Prostate Cancer?

A
  • Sipuleucel-T [CAR-T]
  • Docetaxel [1st line - alone or with…]
  • Cabazitaxel [2nd line]
  • Radium-223 [bone metas]
  • Abiraterone + Predinisone
  • Enzalutamide
41
Q

What is important to know about Cabazitaxel in Prostate Cancer?

A
  • 2nd Line
  • Binds to tublin promoting assembly
  • Unlike other taxanes?
  • More severe toxicites
42
Q

What are some of the chemotherapy options for Metastatic Disease in M1CSPC?

A
  • Docetaxel + Prednisone
  • Cabazitaxel + Prednisone
  • Mitoxantrone + prednisone
43
Q

What is the ONLY medication that is used in Bone Metastases in Prostate Cancer?

A
  • Radium-223
44
Q

How does Radium 223 work within Prostate Cancer?

A
  • Emits high energy to the bone metastases causing it to radiate and get destroyed
  • Used in CRPC
  • LOTS of myelosuppression

PHRM 864: Therapeutics IV (28 decks)

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