Prostate Cancer Flashcards
Which major cell type is responsible for a vast majority of prostate cancer cases?
Adenocarcinoma
What are risk factors for prostate cancer?
- African American
- Age >65
- Men with 1st generation relative who had prostate cancer
- BRCA-2 mutation
- Lynch syndrome
What are some advanced disease complications of prostate cancer?
- Back pain
- Cord compression
- Lower-extremity edema
- Pathologic fractures
- Anemia
- Weight loss
What are prognostic factors of prostate cancer?
- PSA
- Tumor size
- Histologic grade (Gleason score)
T/F: A high PSA is diagnostic of prostate cancer
FALSE: other markers are required
What are the three parts of the staging system for prostate cancer testing?
- Tumor
- Node
- Metastasis
After trying castration, what treatment options do we have for metastatic adenocarcinoma prostate cancer?
- Abiraterone
- Docetaxel x 6 cycles
- Enzalutamide
What is the gold standard for advanced prostate cancer?
Androgen deprivation therapy
- Surgical castration (bilateral orchiectomy)
- Medical castration (luteinizing hormone receptor modulators)
What is the goal serum testosterone of LHRH therapy after 1 month?
<50 ng/dL
What are the LHRH agonists?
- Goserelin
- Leuprolide
- Triptorelin
- Histrolin
What are acute ADEs of LHRH agonists?
- Tumor flare
- Hot flashes
- ED
- Edema
- Gyno
- Injection site reactions
What are long-term ADEs of LHRH agonists?
- Osteoporosis
- Fracture
- Obesity
- Diabetes
- CV events
- HLD
What supplementation should be given with LHRH agonists?
- Vitamin D
- Calcium
What are the LHRH antagonist drugs?
- Degarelix
- Relugolix
What are the first generation antiandrogens?
- Bicalutamide
- Flutamide
- Nilutamide
What should be monitored while a patient is on antiandrogens?
- LFTs*
- Testosterone
- PSA
- Pulmonary function
What are the second generation antiandrogens?
- Apalutamide
- Enzalutamide
- Darolutamide
T/F: Patients on androgen blockade therapy typically relapse within 2-4 years
TRUE
Which treatment has significant benefit for patients with high-risk castration-sensitive prostate cancer?
ADT + Abiraterone or Apalutamide or Enzalutamide
Which treatment improves survival for patients with high-volume castration-sensitive metastatic prostate cancer fit for chemotherapy?
ADT + Docetaxel + Abiraterone or Darolutamide
What defines castration-resistant prostate cancer?
Serum testosterone <50 ng/dL with continued disease progression
When is hormonal therapy strongly recommended in castration-resistant non-metastatic prostate cancer?
If PSA doubling time is <10 months
What treatment can be used for M1 CRPC (PSADT <10mo) and involves an androgen metabolism inhibitor?
Abiraterone with prednisone or methylprednisolone
When does apalutamide need to be IMMEDIATELY discontinued?
If a seizure occurs during treatment
Which 2nd generation antiandrogen needs to be given with food?
Darolutamide
What are the preferred regimens for M1 CRPC with no prior docetaxel and no prior hormone therapy?
- Abiraterone
- Docetaxel
- Enzalutamide
What are the preferred regimens for M1 CRPC with no prior docetaxel, but prior novel hormonal therapy?
- Docetaxel
- Olaparib or rucaparib (BCRA mutation)
What are the preferred regimens for M1 CRPC with no prior novel hormonal therapy, but prior docetaxel?
- Abiraterone
- Cabazitaxel
- Enzalutamdie
What are the preferred regimens for M1 CRPC with prior novel hormonal therapy and prior docetaxel?
- Cabazitaxel
- Docetaxel rechallenge
What treatment can be considered for patients with visceral metastases?
Docetaxel
What treatment can be considered for patients with minimal-to-no symptoms, no liver metastases, life expectancy >6 months, and ECOG performance status
Sipuleucel-T
What are ADEs of docetaxel?
- Alopecia
- Edema
- Peripheral neuropathy
- Hypersensitivity reaction
- Myelosuppression
Why are steroids used with abiraterone?
To minimize the mineralocorticoid excess
T/F: Zytiga and Yonsa have a 1:1 dose conversion
FALSE
Which CRPC treatment is a PARP inhibitor that can cause neutropenia and cancer?
Olaparib
When is radium-223 used?
Symptomatic bone metastases WITHOUT visceral metastases prior to and after docetaxel therapy
What is Lu-177 approved for?
PSMA-positive M1 CRPC
What drugs can be used to prevent skeletal-related events in PC due to metastases?
- Zoledronic acid
- Denosumab
