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PHRM 864 > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

risk factors for prostate cancer

A

high fat diet
textile/industrial workers
Vit E/soy is protective
long term vasectomy >20 years

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2
Q

symptoms of prostate cancer 5

A

few in early
later:
urinary changes
impotence
anemia
weight loss
lower edema

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3
Q

what grading score is used in prostate cancer

A

gleason score

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4
Q

what is the Gleason score

A

score after 2 biopsies
higher score means more aggressive and poorly differentiated

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5
Q

what kind of cancers are in the pathology

A

adenocarcinomas

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6
Q

normal PSA value

A

0-4

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7
Q

evaluation at what PSA

A

> 4

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8
Q

highly suspicious of cancer at what PSA

A

> 10

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9
Q

PSA velocity of increase concern

A

> 0.75 / year

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10
Q

m0 disease is what

A

not metastatic
rise in PSA

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11
Q

m1 is what

A

metastatic
(seen on scans)

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12
Q

localized cancer treatment options

A

active surveilance
radiation
surgery

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13
Q

radiation side effects

A

bladder issues
ED

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14
Q

what can we add to radiation if high Gleason score

A

ADT (hormonal) like GnRH analogs

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15
Q

what is surgery with prostate

A

prostatectomy

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16
Q

what is ADT composed of?

A

LNRH agonist +/-
anti-androgen or orchioectomy

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17
Q

goal level of testosterone afte 1 month

A

<50

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18
Q

LNRH agonists drugs

A

leuprolide
goserelin
regolix

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19
Q

LNRH agonist side effects 7

A

hot flash
gynecomastia
ED
osteporosis
obesity
insulin resistnace
cardiac risk

20
Q

which LNRH to use if cardiac hx?

A

regolix (oral)

21
Q

what drug do we give with LNRH to avoid flare

A

antiandrogens

22
Q

antiandrogen drugs

A

flutamide
bicalutamide most common
nilutamide

23
Q

when should we start antiandrogens if giving an LNRH injection in metastatic pt

A

one week before injection

24
Q

when to give ADT with PSA level in metastatic

A

when doubling time < 6 months

25
Q

when not to give ADT (observe) in metastatic

A

> 6 month doubling

26
Q

which medications can we do intermittent therapy when PSA gets to normal

A

antiandrogens (lutamides)q

27
Q

if we fail m0HSPC treatment with LNRH + antiandrogen what is it classified as now

A

m0CRPC

28
Q

m0CRPC treatment

A

continue LNRH
add enzalutamide,darolutamide, or apalutamide

29
Q

enzalutamide caution

A

seizure history

30
Q

enzalutamide toxicities

A

fatigue, seizures, falls, weakness, diarrhea, hot flash, HTN, pain, headache

31
Q

apalutamide toxicities

A

seizure
HTN, fatigue, falls, rash, diarrhea

32
Q

darolutamide differences

A

way less toxic
structurally different

33
Q

which antiandrogens are most and least toxic order

A

most - enzalutamide
apalutamide
darolutamide

34
Q

what is first line for m1HSPR low volume

A

LNRH and
abiraterone + prednisone
enzalutamide
apalutamide

35
Q

what is abiraterone MOA

A

inhibits CYP17
prevents testosterone formation

36
Q

what must be given with abiraterone

A

prednisone for adrenal insufficiency

37
Q

high volume therpay for m1HSPR

A

ADT
ADT + enzalutamide
ADT + abiraterone
ADT +docetaxel + abiraterone/darolutamide

38
Q

what is high volume?

A

4 + bone mets
visceral mets
one met beyond pelvis

39
Q

what agent could be used in CSPR as second line thats chemo?

A

carbazitaxel

40
Q

what agent can we use for bone mets?

A

Radium 223 dichloride

41
Q

when would we use pembrolizumab in prostate cancer

A

if dMMR or MSI-H

42
Q

which drug has implant

A

goserelin

43
Q

what age should men start to talk about prostate

A

50
45 if high risk

44
Q

what PSA level is annual screening reccomended

A

PSA > 2.5

45
Q

what PSA level is screening reccomended every 2 years

A

PSA <2.5

46
Q

what drug can be taken as prevention in prostate cancer and for who

A

finasteride x 7 years in high ris

PHRM 864 (23 decks)

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