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oncology > prostate cancer > Flashcards

prostate cancer Flashcards

1
Q

risk factors for prostate cancer

A

age (>50)
race (black>white>asian)
family history (double risk)
genetics (BRCA1, BRCA2, Lynch syndrome)

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2
Q

what is the prostate gland responsible for

A

fluid for semen, role in ejaculation, produces PSA

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3
Q

PSA

A

prostate specific antigen (protein produced by prostate and measured by a blood test)
the primary screening modality for PRCA. normal range is undetectable

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4
Q

hormonal regulation of androgen synthesis is mediated by ____

A

negative feedback loop, involving the hypothalamus, pituitary gland, adrenal glands, testes

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5
Q

prostate cancer screening

A

males ages 55-69

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6
Q

when is screening NOT recommended

A

males <40
males 40-54 at average risk
life expectancy <10 years

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7
Q

signs and symptoms of prostate cancer

A
  1. local disease typically asymptomatic
  2. locally invasive disease: ureteral dysfunction including frequency, hesitancy, dribbling; impotence
  3. advanced disease: weight loss, lower extremity edema, anemia. bone mets: back pain, pathological fractures
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8
Q

what is gleason score

A

determined by a pathologist, ranges from 6-10 and correlates to grade groups 1-5
can help make treatment decisions

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9
Q

treatment options for LOCALIZED disease

A

goal is cure
1. surgery: radical prostatectomy
2. androgen deprivation therapy, including orchiectomy
3. radiation
4. active surveillance

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10
Q

options for androgen deprivation therapy

A

bilateral orchiectomy
LHRH agonist
LHRH agonist + 1st gen antiandrogen
LHRH antagonist

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11
Q

treatment options for ADVANCED disease

A
  1. ADT
  2. Radiation
  3. Active surveillance
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12
Q

LHRH agonists

A

leuprolide, goserelin, triptorelin

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13
Q

LHRH agonist initial/later effects

A

initially increases LH/ACTH production
Later on, continued LHRH stimulation shuts down LH/ACTH production

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14
Q

dosing for LHRH agonists in general

A

parenteral: IM or SQ

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15
Q

RX ADT toxicities

A

↑ osteoporosis, risk for fractures
↓muscle mass/strength, ↓size of penis & testicles
↑breast size/soreness, hot flash
↑CV risk, insulin resistance, lipid changes, obesity

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16
Q

LHRH agonists are just as effective as _____

A

orchiectomy

17
Q

1st gen antiandrogens

A

nilutamide, flutamide, bicalutamide

18
Q

1st gen antiandrogens MOA

A

inhibits androgen receptor binding & uptake by prostate cancer cells

19
Q

uses for 1st gen antiandrogens

A

NOT MONOTHERAPY
should be used when starting LHRH agonists to prevent testosterone flare

20
Q

1st gen antiandrogens dosing generally

A

PO

21
Q

LHRH antagonists

A

degarelix and relugolix

22
Q

pearls for LHRH antagonists

A

no initial increase in LH/ACTH= no testosterone flare
quicker drop in testosterone
lower risk of cardiac events

23
Q

LHRH antagonists dosing, generally

A

degarelix is SQ
relugolix is PO

24
Q

what are the options for ADT in mPRCA

A
  1. bilateral orchiectomy, LHRH agonist, LHRH agonist + 1st gen antiandrogen, LHRH antagonist
    PLUS/MINUS DOCETAXEL
  2. bilateral orchiectomy, LHRH agonist, LHRH antagonist
    PLUS/MINUS abiraterone or 2nd generation
25
Q

2nd gen antiandrogens

A

apalutamide
enzalutamide
darolutamide

26
Q

2nd gen antiandrogens are _____ than 1st gens

A

stronger, broader

27
Q

2nd gen antiandrogens dosing, generally

A

PO

28
Q

2nd gen antiandrogens pearls

A

DRUG INTERACTIONS: REALLY BAD
CYP3A4 AND OTHERS
NEED TO CHECK DDIS

29
Q

mechanism of abiraterone

A

potent, selective, irreversible CYP17 inhibitor; interferes with androgen biosynthesis in adrenals & peripheral tissues

30
Q

abiraterone side effects

A

excess mineralocorticoid (HTN, hypokalemia, edema)
fatigue, hot flash, liver toxicity

31
Q

abiraterone dosing considerations

A

PO on an empty stomach
ALWAYS give with low dose prednisone 5 mg
check CYP interactions

32
Q

what is CRPC

A

castration-resistant prostate cancer
progression despite castrate levels of testosterone (<50 ng/dL)

33
Q

options for M0 CRPC

A

PSADT>10 months: monitoring preferred
PSADT<10 months: 2nd gen antiandrogen

34
Q

options for M1 CRPC

A

continue ADT
add RANKL inhibitor or bisphosphonate if metastatic to bone, can do palliative XRT for painful bone mets, best supportive care

35
Q

sipuleucel-T (Provenge) uses?

A

indicated for mCRPC adenocarcinoma but limited use: no previous Tx with docetaxel or novel hormone therapy, minimally symptomatic with no liver mets

oncology (19 decks)

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