Prostate Cancer Flashcards
Median age of diagnosis for prostate cancer
72 years old
What are 7 risk factors of prostate cancer?
- Age
- Sex
- Race
- Family History
- BPH
- Increased testosterone exposure
- Diet
Why should you not use the 5-alpha reductive inhibitors?
Patients can develop a more aggressive form
What are the 3 screening techniques used?
- Digital rectal exam (DRE)
- Prostate specific antigen (PSA)
- Transrectal ultrasonography
Glycoprotein produced by prostate epithelial cells
Prostate specific antigen
Higher levels of PSA = ?
Increased risk of prostate cancer
All men >50 should be offered to take what two tests?
- PSA
- DRE
If a patients life expectancy is <10 years, should they be screening for prostate cancer?
No
Early stages/ localized disease is __________.
Asymptomatic
Since prostate cancer is an advanced metastatic disease, what 5 things does it cause?
- Lower extremity edema
- Hematuria or blood in the semen
- Bone fracture pain/fractures
- Anemia
- Weight loss
What are 3 metastatic sites for prostate cancer?
- Bone
- Lung
- Liver
Test that determines the aggressiveness of PC
Gleason Score
What is the worst prognosis you can get for the Gleason score?
10
What stages of PC are confined to the prostate?
T1 and T2
What are the options for treatment in localized pc?
- Active surveillance
- Radical prostatectomy
- Radiation Therapy
What is premise for active surveillance?
That PC is benign and indolent
When is active surveillance the most appropriate? 2
- < 10 years of life expectancy
- Low grade disease
What are two complications pc patients face with radiation?
- Impotence
- Rectal/bladder symptoms
What are your options for stage 3 pc?
- Radiation +/- ADT
- ADT
What are the 2 first line hormonal therapies?
- Androgen Ablation
- Combined androgen blockade
What is combined androgen blockade?
LHRH agonist + antiandrogen
What is the MOA for androgen ablation therapy?
Surge of LHRH leading to increased production of LH and ACTH
What are 2 limitations to Androgen Ablation therapy?
- Disease Flare
- Expensive
How long would you add an antiandrogen to suppress an LH/ACTH flare?
7 days
What are the 3 Androgen Ablation agonists?
- Leuprolide
2.Goserelin - Triptorelin
What are 6 ADRS of Androgen ablation therapy?
- Hot flashes
- Erectile impotence
- Decreased libido
- Metabolic Complications
- CVD
- Osteoporosis
What is the most commonly used antiandrogen?
Bicalutamide
Bicalutamide
CASODEX
Goserelin
ZOLADEX
Hormone refractory occurs when the serum testosterone is what?
< 50
Abiraterone
Zytiga
What should zytiga be used with?
Prednisone
What does zytiga selectively and irreversibly inhibit?
Cyp17
What is a complication with zytiga?
Interacts with most drugs
How should you take Abiraterone?
On an empty stomach
What’s are the 4 first line agents for hormone refractory?
- Abiraterone
- Androgen R inhibitors
- Relugolix
- Docetaxel
What 3 things do androgen R inhibitors do?
- Inhibits androgens from binding to the receptor
- Inhibits androgen R from entering the cell nucleus
- Inhibits androgen R binding
What are the 3 Androgen R inhibitors?
- Enzalutamide
- Apalutamide
- Darolutamide
Enzalutamide
XTANDI
Apalutamide
ERLEADA
Darolutamide
NUBEQA
Do androgen R inhibitors require concurrent use with prednisone?
No
What is zytiga considered as?
An antiandrogen
WHAT DOES DOCETAXEL INHIBIT?
Depolymerization of tubulin
Docetaxel
TAXOTERE
What is the regimen for stage 4 Pc?
- ADT
- Secondary hormonal therapy
- Chemotherapy
What two drugs are used to prevent skeletal related events?
- Zoledronic acid
- Denosumab
Zoledronic Acid
Zometa
Denosumab
XGEVA
Triptorelin
TRELSTAR