Prostate Cancer

Question 1

risk factors for prostate cancer

Answer 1

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

Question 2

symptoms of prostate cancer 5

Answer 2

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

Question 3

what grading score is used in prostate cancer

Answer 3

gleason score

Question 4

what is the Gleason score

Answer 4

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

Question 5

what kind of cancers are in the pathology

Answer 5

adenocarcinomas

Question 6

normal PSA value

Answer 6

0-4

Question 7

evaluation at what PSA

Answer 7

> 4

Question 8

highly suspicious of cancer at what PSA

Answer 8

> 10

Question 9

PSA velocity of increase concern

Answer 9

> 0.75 / year

Question 10

m0 disease is what

Answer 10

not metastatic
rise in PSA

Question 11

m1 is what

Answer 11

metastatic
(seen on scans)

Question 12

localized cancer treatment options

Answer 12

active surveilance
radiation
surgery

Question 13

radiation side effects

Answer 13

bladder issues
ED

Question 14

what can we add to radiation if high Gleason score

Answer 14

ADT (hormonal) like GnRH analogs

Question 15

what is surgery with prostate

Answer 15

prostatectomy

Question 16

what is ADT composed of?

Answer 16

LNRH agonist +/-
anti-androgen or orchioectomy

Question 17

goal level of testosterone afte 1 month

Answer 17

<50

Question 18

LNRH agonists drugs

Answer 18

leuprolide
goserelin
regolix

Question 19

LNRH agonist side effects 7

Answer 19

hot flash
gynecomastia
ED
osteporosis
obesity
insulin resistnace
cardiac risk

Question 20

which LNRH to use if cardiac hx?

Answer 20

regolix (oral)

Question 21

what drug do we give with LNRH to avoid flare

Answer 21

antiandrogens

Question 22

antiandrogen drugs

Answer 22

flutamide
bicalutamide most common
nilutamide

Question 23

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

Answer 23

one week before injection

Question 24

when to give ADT with PSA level in metastatic

Answer 24

when doubling time < 6 months

Question 25

when not to give ADT (observe) in metastatic

Answer 25

> 6 month doubling

Question 26

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

Answer 26

antiandrogens (lutamides)q

Question 27

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

Answer 27

m0CRPC

Question 28

m0CRPC treatment

Answer 28

continue LNRH add enzalutamide,darolutamide, or apalutamide

Question 29

enzalutamide caution

Answer 29

seizure history

Question 30

enzalutamide toxicities

Answer 30

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

Question 31

apalutamide toxicities

Answer 31

seizure HTN, fatigue, falls, rash, diarrhea

Question 32

darolutamide differences

Answer 32

way less toxic structurally different

Question 33

which antiandrogens are most and least toxic order

Answer 33

most - enzalutamide apalutamide darolutamide

Question 34

what is first line for m1HSPR low volume

Answer 34

LNRH and abiraterone + prednisone enzalutamide apalutamide

Question 35

what is abiraterone MOA

Answer 35

inhibits CYP17 prevents testosterone formation

Question 36

what must be given with abiraterone

Answer 36

prednisone for adrenal insufficiency

Question 37

high volume therpay for m1HSPR

Answer 37

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

Question 38

what is high volume?

Answer 38

4 + bone mets visceral mets one met beyond pelvis

Question 39

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

Answer 39

carbazitaxel

Question 40

what agent can we use for bone mets?

Answer 40

Radium 223 dichloride

Question 41

when would we use pembrolizumab in prostate cancer

Answer 41

if dMMR or MSI-H

Question 42

which drug has implant

Answer 42

goserelin

Question 43

what age should men start to talk about prostate

Answer 43

50 45 if high risk

Question 44

what PSA level is annual screening reccomended

Answer 44

PSA > 2.5

Question 45

what PSA level is screening reccomended every 2 years

Answer 45

PSA <2.5

Question 46

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

Answer 46

finasteride x 7 years in high ris