Prostate Cancer

Question 1

What are four very high risk features of prsotate cancer?

Answer 1

cT3b-T4
Primary Gleason 5
2 or 3 high risk features
>4 cores with GG4 or 5

Question 2

What are three high risk features in prostate? How many do you need to qualify as high risk?

Answer 2

Exactly one of:
cT3
GG4 or GG5
PSA >20

Question 3

How to differentiate unfavorable intermediate vs favorable?

Answer 3

Unfavorable has GG3 or >50% biopsy cores positive
Favorable has GG 1-2 or <50% cores positive
Unfavorable also has 2 or 3 intermediate risk factors vs 1 (T2b=T2c, GG 2 or 3, PSA 10-20)

Question 4

When to order bone scan or soft tissue imaging in newly diagnosed prostate cancer?

Answer 4

Unfavorable intermediate risk or higher

Question 5

who is appropriate for active surveillance?

Answer 5

Very low risk with 10-20 year survival
low risk with at least 10 year survival

Question 6

Definition of PSA recurrence after surgery?

Answer 6

PSA >0.1 or 2 or more increases
PSA persistence is never becoming undetectable

Question 7

Definition of PSA recurrence after RT?

Answer 7

Increase by 2ng/mL above nadir

Question 8

Preferred treatment strategy for de novo metastatic HSPC with high volume disease?

Answer 8

ADT + Docetaxel + Abiraterone/Darolutamide

Question 9

Treatment options for de novo metastatic HSPC without high volume disease? (3)

Answer 9

ADT+ Abi, apa, enza

Question 10

What is the effect on survival for radiation to oligometastatic disease?

Answer 10

Improves PFS

Question 11

Treatment options for M0 CRPC (3)

Answer 11

ADT +
Apa
Enza
Daro

Question 12

Which is more common in prostate cancer, BRCA2 or BRCA1?

Answer 12

BRCA2

Question 13

4 PARPi that are approved for mCRPC

Answer 13

Olaparib
Rucaparib
Talazoparib +/- Enzalutamide
Niraparib + Abiraterone

Question 14

Definition of high volume metastatic disesase

Answer 14

Visceral mets or
4 or more bone mets (at least one met beyond pelvis-vertebrae)

Question 15

4 adverse findings to be seen on a prostatectomy specimen

Answer 15

POstiive margin
seminal vesicle involvement
extracapsular extension (pT3a)
Detectable PSA

Question 16

What is the difference between adjuvant RT and observation then salvage RT in patients with adverse findings after prostatectomy?

Answer 16

More toxicity in adjuvant RT, no benefit in survival compared to salvage RT

Question 17

What types of patients with mCRPC are candidates for Sipuleucel-T?

Answer 17

Asymptomatic or minimally symptomatic
No liver mets
ECOG 0-1

Question 18

Treatment options (2) for unfavorable intermediate risk disease?

Answer 18

RP + PLND or
EBRT + ADT 4-6 months

Question 19

Treatment for favorable intermediate disease with life expectancy >10 years (3)

Answer 19

Surveillance
EBRT
Prostatectomy +/- PLND

Question 20

Treatment for high-risk prostate cancer?

Answer 20

EBRT + ADT (long term)
EBRT + ADT + Abi (if PSA >40)
RP + PLND

Question 21

Patient with unfav intermed disease goes for upfront RP and PLND. Has extracapsular extension, positive margins, and 1 LN was positive. Treatment?

Answer 21

Adjuvant ADT + EBRT
Technically could observe but nobody does

Question 22

Preferred treatment for mCRPC that has progressed on docetaxel and abi (or enza)?

Answer 22

Cabazitaxel

Question 23

Indication for niraparib + abi?

Answer 23

mCRPC with BRCA mutation

Question 24

Indication for olaparib+Abi

Answer 24

mCRPC with BRCA mutation

Question 25

Indication for Talazoparib + Enza

Answer 25

mCRPC with HRR mutation (BRCA 1/2, ATM, CDK12, CHEK2, MLH1, PALB2, RAD51C)

Question 26

Indications for enzalutamide + ADT in the biochemical recurrent setting

Answer 26

High risk:
PSADT <9 mon
PSA >2 above RT nadir or >1 after RP +/- postop RT