prostate cancer

Question 1

Gleason Score Groups

Answer 1

• Low risk→ Grade Group 1 → Pattern = 6 or less score
• High risk→ Grade Group 4+ 5 → pattern = 8,9,10 score

Question 2

Risk Factors for prostate cancer

Answer 2

• African Americans
• age 65-74
• 1st deg family hx of prostate
• genotype- BRCA 2 + Lynch Syndrome

Question 3

when is surgery appropriate in prostate cancer

Answer 3

tumor confined to prostate and life expectancy 10 or more years

Question 4

Androgen Deprivation Therapy (Prostate)

Answer 4

• Surgical castration
• Medical castration
  →LHrH agonist +/- antiandrogen
  → LHrH antagonisit

Question 5

LHrH agonist -relin, -rolide; clinical pearls, SE, counseling

Answer 5

• Extended dosing intervals
• SE: osteoporosis, hot flashes, tumor flares, edema, inj site rxn, osteoporosis, obesity, insulin resistance
• initial tumor flare from inc testosterone production resolves in 2 weeks
• bone mineral density → supp w/ca + vit D

Question 6

LHrH antagonist -lix clinical pearls, AEs

Answer 6

• no tumor flare, Faster castration (dec testosterone)
• frequent dosing, exposure
• SE: hot flashes, weight gain, inj site rxns, osteoporosis

Question 7

Antiandrogens -amide clinical pearls

Answer 7

• 2nd gen
  Apalutamide - SEIZURES, fatigue, HTN rash, diarrhea, nausea, arthralagias, fracture risk, edema
  Darulotamide - better tolerated, fatigue, HTN, rash, USE w/ seizures
  Enzalutamide - SEZIURES, diarrhea, fatigue, HA, myalgias

Question 8

Local disease

Answer 8

• low risk <10 life expectancy → observe, more than 10 active surveillance

Question 9

Regional Disease

Answer 9

• Involes lymph nodes
• Preferred: EBRT + ADT + abiraterone

Question 10

what to do if PSADT > or < 10 months

Answer 10

• > 10 months→ monitor or secondary therapy
• <10 months→ 2nd gen anti

Question 11

M1 no prior docestaxel/ no ADT preferred regimen

Answer 11

Abiraterone, Docetazel, Enzalutamide

Question 12

M1 no prior docetaxel/ prior ADT preferred regimen

Answer 12

Docetazel, Olaparib or Rucaparib

Question 13

M1 Prior docetaxel/ no ADT Preferred regimens

Answer 13

Abiraterone, Cabazitaxel, Enzalutamide

Question 14

M1 Prior docetaxel and prior ADT preferred regimen

Answer 14

• cabazitaxel, docetaxel

Question 15

what agent to use in visceral metases

Answer 15

Docetaxel

Question 16

What to do in symptomatic bone metastases only

Answer 16

• radium 23

Question 17

what to do in asymptomatic or minimal symptoms, life expect >6 mon, good performance

Answer 17

Sipuleucel T

Question 18

Docetaxel clinical pearls

Answer 18

Gold standard
- hepatic impairment
- edema , neuropathy, myleosuppression

Question 19

Abiraterone clinical pearls

Answer 19

• diarrhea, edema, hypokalemia, HTN, inc trigs
• add steriolds
• monitor LFTs, K, phosphate, BP monthly

Question 20

Olaparib AE

Answer 20

• upper resp inf, leukemia, neutropenia, abdominal pain
• risk of developing secondary cancer

Question 21

Radium 23 clinical pearls

Answer 21

• iv monthly
• do not use w/ chemo
• se: edema, nausea, myleosuppression

Question 22

Sipuleucel T clinical pearls

Answer 22

• dendritic cell vaccine
• taken from pt reinfued

Question 23

Cabazitaxel clinical pearls

Answer 23

• good for Docetaxel resistant patients
• AE: febrile neutropeina, hypersensitivity rxn, mucositis, edema

Question 24

when to use Lutetium Lu 177

Answer 24

Patients w/ PSMA + MI CRPC

Question 25

Supportive care

Answer 25

• calcium 1000-1200 mg QD + vit d 400-800 IU QD for frature risk
• zoledronic acid + denosumab for bone modifying agents
• screen for diabetes and CVD on ADT