Prostate Cancer Flashcards
What 2 sources of androgens does prostate cancer treatment take into account?
Testes
Adrenals
What is first line tx for prostate cancer?
Medical or surgical castration: anti androgen drugs
What type of brachytherapy is used in PC?
I 125
What are the anterior pituitary drug targets for PC?
ACTH
LH
17-a hydroxylase (adrenals)
Androgen receptors
What are the GnRH agonist drugs?
-relin and leupron Goserelin Histrelin Leuprolide Triptorelin
What are the GnRH antagonist drugs?
Degarelix
GnRH MOA/AE?
MOA:
GnRH agonist: continuous: down regulate
AE: Decrease bone density (fracture) LDL increase, TG increase Cardiac: MI/DVT/etc... estrogen loss weight gain (low T) Diabetes mellitus sexual dysfunction gynecomastia decrease libido Edema HTN HA depression fatigue myalgia
SC GnRH agonists?
Goserelin
Histrelin
Leurolide
IM GnRH agonists?
Leuprolide
Triptorelin
GnRH agonist with Seizure and Suicide risk?
Histrelin (hystreonic?)
GnRH agonist with MI and CHF risk?
Leuprolide
What is notable about FSH/LH and sex hormones early in GnRH agonist tx?
High early, low late
What is difference in agonists and antagonist of GnRH in terms of sex hormones?
Agonist: high early
Antagonist: no spike
What is the GnRH antagonist?
Degarelix
How long does agonist take to castrate? Antagonist?
Agonist: 2-4 weeks
Antagonist: 3 days!… much faster, no flare. Worse AE: heart and liver
GnRH antagonist administration?
SC (not IM)
Degarelix MOA, AE?
MOA: GnRH antagonist
AE: Elevated liver enzymes Liver toxicity QT prolongation HTN Hot flashes Impotence arthralgia
What are the androgen receptor blockers?
-mide:
Bicalutamide
Flutamide
Androgen receptor blocker MOA, AE?
MOA:
Directly block T and DHT effects on tumor
AE:
GI toxicity
Hot flashes
Arthralgia, myalgia
TERATOGENS!!!!
Sipulence MOA/AE?
MOA:
take patients APCs and modify them to attack cancer and put back in: T cells stimulated
*T cells become immune to prostatic acid phosphatase, more effective
AE:
*Parasthesia
*Citrate toxicity
GI
Flu like (immunomodulation)
Dyspnea
Abiraterone MOA/AE?
MOA:
Inhibit 17-a hydroxylase in adrenals
Prevent DHEA production
*Boosts ACTH and Aldo–>HTN
AE:
*HTN: Increased mineralocorticoid production!
Low K: arrhythmias
Edema
CV issues: caution
Monitor LFTs
CAT X: semen spreads it!
*
What drug is spread by semen?
Abiraterone: 17 a OH inhibitor
What drug has parasthesias?
Sipuleucel
What should not be used in PC?
5a reductase inhibitors: increase risk Ca
