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Oncology boards > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

Category 1 drugs for non metastatic castrate resistant prostate cancer

A

apalutamide
darolutamide
enzalutamide
*abiraterone not approved

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2
Q

docetaxel metabolization and contraindication

A

hepatic, contraindicated with hyperbili

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3
Q

Abiraterone mechanism

A

Inhibits CYP17 to inhibit androgen biosynthesis

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4
Q

Metabolic interaction with abiraterone

A

Inhibits CYP17

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5
Q

abiraterone toxicity

A

*CHF
hypokalemia
HTN
hepatotoxicity

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6
Q

Enzalutamide/apalutamide/darolutamide mechanism

A

AR receptor blockers preventing translocation of AR to nucleus

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7
Q

Enzalutamide/apalutamide/darolutamide drug interaction

A

Warfarin and other blood thinners (confirm)

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8
Q

Apalutamide SE’s

A

hypothyroidism
rash
peripheral edema
arthralgias

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9
Q

ARPI with least cognitive toxicity

A

darolutamide (low CNS penetration)

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10
Q

approved PARP/ARPI combinations

A

olaparib or niraparib + abiraterone
talazoparib + enzalutamide

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11
Q

T4 prostate cancer

A

Tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall

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12
Q

T3 prostate cancer

A

Extraprostatic tumor that is not fixed or does not invade adjacent structures

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13
Q

T3b prostate cancer

A

Seminal vesicle invasion

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14
Q

T3a prostate cancer

A

Extraprostatic extension (unilateral or bilateral)

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15
Q

T2 prosate cancer

A

Tumor is palpable and confined within prostate

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16
Q

T2a prostate cancer

A

Tumor involves one-half of one side or less

17
Q

T2b prostate cancer

A

Tumor involves more than one-half of one side but not both sides

18
Q

T2c prostate cancer

A

Tumor involves both sides

19
Q

What is considered high grade based on gleason score?

A

GS 8-10

20
Q

When PSMA is indicated in localized prostate cancer

A

High or very high risk disease (unfavorable intermediate is controversial)

21
Q

NCCN criteria for high risk

A

No very high risk features
AND
T3a OR
Grade group 4 or 5 OR
PSA >20 ng/mL

22
Q

Management of low risk or favorable intermediate risk

A
  • 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)
23
Q

STAMPEDE criteria for intensification of therapy in localized disease setting

A

node positive on conventional scan OR 2 of following: T3/T4, grade group 4 to 5 (GS 8-10), PSA ≥40 ng/mL)

24
Q

Unfavorable intermediate
*Relevant since this is when imaging is indicated

A
  • 2 or 3 intermediate risk features
  • Grade Group 3
  • > 50% biopsy cores positive (>6 of 12)
25
Q

Next step for low risk prostate cancer after biopsy

A

MRI (part of diagnostic/treatment prognositcation to determine if a patient is appropriate for entry into active surveillance protocol)

26
Q

Preferred biopsy approach

A

TRUS in conjunction with MRI-targeted biopsy (MRI targeted biopsy may miss high grade cancers)

27
Q

When prostate cancer screening is indicated for high risk patients + 2) what defines high risk

A

40
2) black, germline mutations, suspicious family history

28
Q

Management of residual lymphadenopathy for locally advanced NSGCT

A

IF >1cm RPLND (residual teratoma or viable NSGCT)

29
Q

Management of residual lymphadenopathy for locally advanced seminoma

A

<3 = surveillance
>3 = PET/CT

30
Q

second line for NGSCT

A
  • 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)
31
Q

Management of NSGCT limited to testis with persistent elevation of tumor markers following orchiectomy

A

BEP for 3 cycles (Stage IS)
*(persistently elevated tumor markers indicate presence of metastatic disease)

32
Q

Drugs approved for NMCRPC

A

enz, apalutamide, and darolutamide

33
Q
A

Oncology boards (41 decks)

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