Prostate cancer Flashcards
Category 1 drugs for non metastatic castrate resistant prostate cancer
apalutamide
darolutamide
enzalutamide
*abiraterone not approved
docetaxel metabolization and contraindication
hepatic, contraindicated with hyperbili
Abiraterone mechanism
Inhibits CYP17 to inhibit androgen biosynthesis
Metabolic interaction with abiraterone
Inhibits CYP17
abiraterone toxicity
*CHF
hypokalemia
HTN
hepatotoxicity
Enzalutamide/apalutamide/darolutamide mechanism
AR receptor blockers preventing translocation of AR to nucleus
Enzalutamide/apalutamide/darolutamide drug interaction
Warfarin and other blood thinners (confirm)
Apalutamide SE’s
hypothyroidism
rash
peripheral edema
arthralgias
ARPI with least cognitive toxicity
darolutamide (low CNS penetration)
approved PARP/ARPI combinations
olaparib or niraparib + abiraterone
talazoparib + enzalutamide
T4 prostate cancer
Tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
T3 prostate cancer
Extraprostatic tumor that is not fixed or does not invade adjacent structures
T3b prostate cancer
Seminal vesicle invasion
T3a prostate cancer
Extraprostatic extension (unilateral or bilateral)
T2 prosate cancer
Tumor is palpable and confined within prostate
T2a prostate cancer
Tumor involves one-half of one side or less
T2b prostate cancer
Tumor involves more than one-half of one side but not both sides
T2c prostate cancer
Tumor involves both sides
What is considered high grade based on gleason score?
GS 8-10
When PSMA is indicated in localized prostate cancer
High or very high risk disease (unfavorable intermediate is controversial)
NCCN criteria for high risk
No very high risk features
AND
T3a OR
Grade group 4 or 5 OR
PSA >20 ng/mL
Management of low risk or favorable intermediate risk
- IF limited life expectancy or significant comorbidities → active surveillance (done by urology)
- IF life expectancy >10 years → active surveillance vs. EBRT vs RP w/ pelvic lymph node dissection
*If intermediate need some form of treatment (Mittal)
STAMPEDE criteria for intensification of therapy in localized disease setting
node positive on conventional scan OR 2 of following: T3/T4, grade group 4 to 5 (GS 8-10), PSA ≥40 ng/mL)
Unfavorable intermediate
*Relevant since this is when imaging is indicated
- 2 or 3 intermediate risk features
- Grade Group 3
- > 50% biopsy cores positive (>6 of 12)
Next step for low risk prostate cancer after biopsy
MRI (part of diagnostic/treatment prognositcation to determine if a patient is appropriate for entry into active surveillance protocol)
Preferred biopsy approach
TRUS in conjunction with MRI-targeted biopsy (MRI targeted biopsy may miss high grade cancers)
When prostate cancer screening is indicated for high risk patients + 2) what defines high risk
40
2) black, germline mutations, suspicious family history
Management of residual lymphadenopathy for locally advanced NSGCT
IF >1cm RPLND (residual teratoma or viable NSGCT)
Management of residual lymphadenopathy for locally advanced seminoma
<3 = surveillance
>3 = PET/CT
second line for NGSCT
- TIP for 4 cycles (Preferred - Superior outcomes, but studied in a more favorable/chemo sensitive population)
- VeIP for 4 cycles (Studied in a more broad group) * (vinblastine, ifosfamide, cisplatin *different than VIP)
Management of NSGCT limited to testis with persistent elevation of tumor markers following orchiectomy
BEP for 3 cycles (Stage IS)
*(persistently elevated tumor markers indicate presence of metastatic disease)
Drugs approved for NMCRPC
enz, apalutamide, and darolutamide
