Prostate Cancer Flashcards
risk factors for prostate cancer
high fat diet
textile/industrial workers
Vit E/soy is protective
long term vasectomy >20 years
symptoms of prostate cancer 5
few in early
later:
urinary changes
impotence
anemia
weight loss
lower edema
what grading score is used in prostate cancer
gleason score
what is the Gleason score
score after 2 biopsies
higher score means more aggressive and poorly differentiated
what kind of cancers are in the pathology
adenocarcinomas
normal PSA value
0-4
evaluation at what PSA
> 4
highly suspicious of cancer at what PSA
> 10
PSA velocity of increase concern
> 0.75 / year
m0 disease is what
not metastatic
rise in PSA
m1 is what
metastatic
(seen on scans)
localized cancer treatment options
active surveilance
radiation
surgery
radiation side effects
bladder issues
ED
what can we add to radiation if high Gleason score
ADT (hormonal) like GnRH analogs
what is surgery with prostate
prostatectomy
what is ADT composed of?
LNRH agonist +/-
anti-androgen or orchioectomy
goal level of testosterone afte 1 month
<50
LNRH agonists drugs
leuprolide
goserelin
regolix
LNRH agonist side effects 7
hot flash
gynecomastia
ED
osteporosis
obesity
insulin resistnace
cardiac risk
which LNRH to use if cardiac hx?
regolix (oral)
what drug do we give with LNRH to avoid flare
antiandrogens
antiandrogen drugs
flutamide
bicalutamide most common
nilutamide
when should we start antiandrogens if giving an LNRH injection in metastatic pt
one week before injection
when to give ADT with PSA level in metastatic
when doubling time < 6 months
when not to give ADT (observe) in metastatic
> 6 month doubling
which medications can we do intermittent therapy when PSA gets to normal
antiandrogens (lutamides)q
if we fail m0HSPC treatment with LNRH + antiandrogen what is it classified as now
m0CRPC
m0CRPC treatment
continue LNRH
add enzalutamide,darolutamide, or apalutamide
enzalutamide caution
seizure history
enzalutamide toxicities
fatigue, seizures, falls, weakness, diarrhea, hot flash, HTN, pain, headache
apalutamide toxicities
seizure
HTN, fatigue, falls, rash, diarrhea
darolutamide differences
way less toxic
structurally different
which antiandrogens are most and least toxic order
most - enzalutamide
apalutamide
darolutamide
what is first line for m1HSPR low volume
LNRH and
abiraterone + prednisone
enzalutamide
apalutamide
what is abiraterone MOA
inhibits CYP17
prevents testosterone formation
what must be given with abiraterone
prednisone for adrenal insufficiency
high volume therpay for m1HSPR
ADT
ADT + enzalutamide
ADT + abiraterone
ADT +docetaxel + abiraterone/darolutamide
what is high volume?
4 + bone mets
visceral mets
one met beyond pelvis
what agent could be used in CSPR as second line thats chemo?
carbazitaxel
what agent can we use for bone mets?
Radium 223 dichloride
when would we use pembrolizumab in prostate cancer
if dMMR or MSI-H
which drug has implant
goserelin
what age should men start to talk about prostate
50
45 if high risk
what PSA level is annual screening reccomended
PSA > 2.5
what PSA level is screening reccomended every 2 years
PSA <2.5
what drug can be taken as prevention in prostate cancer and for who
finasteride x 7 years in high ris
