Prostate Cancer

Question 1

When is neoadjuvant chemotherapy recommended in penile cancer?

Answer 1

In nodal disease

Question 2

Features of NCCN low risk early prostate cancer?

Answer 2

Gleason 3+3
PSA <10
T1/T2 tumour

Question 3

Features of intermediate risk early prostate cancer?

Answer 3

Gleason 3+4 or 4+3
PSA <20
T1/2 tumour

Question 4

Features of NCCN high risk early prostate cancer?

Answer 4

Gleason 4+4 or higher
PSA >20
T3a

Question 5

Management of NCCN low risk early prostate cancer?

Answer 5

Surveillance

Question 6

Management of intermediate risk early prostate cancer?

Answer 6

Generally would treat. Surgery <70yrs or RT +- ADT. No clear difference between surgery and RT in this group.

Question 7

Management of high risk early prostate cancer?

Answer 7

EBRT with 6 months of ADT

Question 8

Management of locally advanced T3b/T4 prostate cancer

Answer 8

Long course ADT (18m to 3yrs) and radiotherapy to prostate +- prophylactic pelvic RT

Question 9

What is the definition of T3b prostate cancer?

Answer 9

Invasion into seminal vesicles

Question 10

In patient with PSA doubling time >10 months and no radiological progression, what is the management?

Answer 10

Continue with PSA and imaging surveillance

Question 11

In patient with PSA doubling time <10 months and no radiological progression, what is the management?

Answer 11

Consider addition or ARSI- apalutamide, darolutamide or enzalutamide. Abiaterone not licensed for this indication.

Question 12

What is considered good risk in setting of metastatic prostate cancer. What is your first line management?

Answer 12

3 or less bone mets
Start ADT and ARSI. Consider radiation to the prostate

Question 13

In patient with PSA doubling time <10 months and no radiological progression who had previous prostatectomy, what is the management?

Answer 13

ARSI as per previous answer. Also consider RT to prostate bed and LNRH

Question 14

What is considered poor risk in setting of metastatic prostate cancer. What is your first line management?

Answer 14

> 4 bone mets +- visceral disease.
ADT + ARSI + Docetaxel if fit

Question 15

Which medications should be prescribed alongside ADT?

Answer 15

Calcium and vitamin D to protect against loss of bone density.

Question 16

Are bisphosphanates/denosumab used in castrate sensitive or castrate resistant disease?

Answer 16

Only shown to be helpful in castrate resistant disease/

Question 17

Why is abiaterone given with prednisolone?

Answer 17

Blocks androgen biosynthesis and cortisol production thereby causing compensatory ACTH production leading to mineralocorticoid excess.

Question 18

What drug may be used in the second line following Docetaxel?

Answer 18

Cabazitaxel (given with prednisolone)

Question 19

When should you consider small cell transformation?

Answer 19

Tumour progression in viscera whilst PSA remains low.

Question 20

What percentage of prostate cancer have somatic and germline BRCA2 mutations?

Answer 20

10% somatic, 5% germline

Question 21

What are the indications for genetic testing in prostate cancer?

Answer 21

Prostate cancer <50yrs
Ashkenazi Jewish ancestry
Metastatic prostate cancer <60yrs
FH of prostate cancer where estimated likelihood of pathognomic variant is at least 10%
Prostate cancer with significant FH of other BRCA related cancers.

Question 22

When is Olaparib licensed in prostate cancer?

Answer 22

In BRCA mutated prostate cancer that has progressed through at least one antiandrogen therapy. Olaparib can be used with abiaterone for ARSI naive patients.

Question 23

When is Radium 233 used?

Answer 23

In castrate resistant metastatic prostate cancer in patients who previously had or are not fit for docetaxel.

Question 24

Which drugs should be avoided with Radium 233?

Answer 24

Abiaterone as increases risk of fracture.

Question 25

Which drugs should be co-prescribed with Radium 233?

Answer 25

Bisphosphonate or denosumab

Question 26

What Mirels score is suggestive of prophylactic fixation?

Answer 26

More than or equal to 9, consider with score of 8

Question 27

Are lytic or sclerotic lesions more prone to fracture?

Answer 27

Lytic

Question 28

Which 4 categories are included in Mirels score?

Answer 28

Site of metastasis (upper limb, lower limb, trochanteric region) % of bone diameter involved (<1/3, 1/3-2/3, >2/3) Type of lesion (blastic/sclerotic, mixed lytic and sclerotic or lytic) Pain (mild, moderate, functional)

Question 29

Which types of cancer typically give rise to lytic bone mets?

Answer 29

Renal NSCLC Breast Melanoma NHL Thyroid

Question 30

What is a frequent side effect of apalutamide?

Answer 30

Rash

Question 31

What could you consider doing in asymptomatic metastatic castrate resistant prostate cancer who have biochemical progression in the absence of radiological progression?

Answer 31

Switching for prednisolone to dexamethasone results in reduction in PSA for 30%

Question 32

What could you consider doing in asymptomatic metastatic castrate resistant prostate cancer who have biochemical progression in the absence of radiological progression?

Answer 32

Switching for prednisolone to dexamethasone results in reduction in PSA for 30%

Question 33

Define castrate resistant disease?

Answer 33

Biochemical or radiological progression in presence of castration levels of testosterone.