Prostate Cancer

Question 1

What 2 sources of androgens does prostate cancer treatment take into account?

Answer 1

Testes

Adrenals

Question 2

What is first line tx for prostate cancer?

Answer 2

Medical or surgical castration: anti androgen drugs

Question 3

What type of brachytherapy is used in PC?

Answer 3

I 125

Question 4

What are the anterior pituitary drug targets for PC?

Answer 4

ACTH
LH
17-a hydroxylase (adrenals)
Androgen receptors

Question 5

What are the GnRH agonist drugs?

Answer 5

-relin and leupron
Goserelin
Histrelin
Leuprolide
Triptorelin

Question 6

What are the GnRH antagonist drugs?

Answer 6

Degarelix

Question 7

GnRH MOA/AE?

Answer 7

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

Question 8

SC GnRH agonists?

Answer 8

Goserelin
Histrelin
Leurolide

Question 9

IM GnRH agonists?

Answer 9

Leuprolide

Triptorelin

Question 10

GnRH agonist with Seizure and Suicide risk?

Answer 10

Histrelin (hystreonic?)

Question 11

GnRH agonist with MI and CHF risk?

Answer 11

Leuprolide

Question 12

What is notable about FSH/LH and sex hormones early in GnRH agonist tx?

Answer 12

High early, low late

Question 13

What is difference in agonists and antagonist of GnRH in terms of sex hormones?

Answer 13

Agonist: high early
Antagonist: no spike

Question 14

What is the GnRH antagonist?

Answer 14

Degarelix

Question 15

How long does agonist take to castrate? Antagonist?

Answer 15

Agonist: 2-4 weeks
Antagonist: 3 days!… much faster, no flare. Worse AE: heart and liver

Question 16

GnRH antagonist administration?

Answer 16

SC (not IM)

Question 17

Degarelix MOA, AE?

Answer 17

MOA: GnRH antagonist

AE:
   Elevated liver enzymes
   Liver toxicity
   QT prolongation 
   HTN
   Hot flashes
   Impotence
   arthralgia

Question 18

What are the androgen receptor blockers?

Answer 18

-mide:
Bicalutamide
Flutamide

Question 19

Androgen receptor blocker MOA, AE?

Answer 19

MOA:
Directly block T and DHT effects on tumor

AE:
   GI toxicity
   Hot flashes
   Arthralgia, myalgia
    TERATOGENS!!!!

Question 20

Sipulence MOA/AE?

Answer 20

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

Question 21

Abiraterone MOA/AE?

Answer 21

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!
*

Question 22

What drug is spread by semen?

Answer 22

Abiraterone: 17 a OH inhibitor

Question 23

What drug has parasthesias?

Answer 23

Sipuleucel

Question 24

What should not be used in PC?

Answer 24

5a reductase inhibitors: increase risk Ca