Prostate Cancer Flashcards
Epidemiology
- Most ___ malignancy in men in US
- 2nd most common cause of cancer related ___ in men
- Estimated that ~16% of men will be diagnosed with prostate cancer during their lifetime (1 in ___ men from birth to death)
- common
- death
- 8
Etiology/Pathogenesis
Hormonal
- ___ is a growth signal to the prostate
- Most risk factors associated with prostate cancer are related to increased exposure to testosterone
Alterations in ___ receptor
- testosterone
- androgen
Risk Factors
Age
- increased lifetime exposure to ___
Race
- More common in ___, less common in Asians
Family History
- testosterone
- African-Americans
Pathology
Grading: ___ score (2 - 10)
- Scores of 2 to 4 are ___ , well differentiated
- Scores of 8 – 10 are ___ , poorly differentiated
- slow growing
- aggressive
Prostate Specific Antigen (PSA)
Liquefies seminal secretions and
increases with disorders of the prostate
* Normal range is ___ - ___ ng/mL
* > 4 ng/mL requires evaluation
* > ___ ng/mL highly suspicious for malignancy
* PSA velocity: > ___ ng/mL rise per year suspicious for malignancy
- 0-4
- 10
- 0.75
Definitions
- m1 = Metastatic (found
on scans) - m 0 = Non-metastatic ( ___ only)
- HSPC = ___ sensitive prostate
cancer - CRPC = ___ resistant prostate
cancer
- PSA
- hormone
- castration
Treatment: Localized
Observation
- Involves monitoring the course of disease with the expectation to deliver palliative therapy for the development of ___
- PSA and DRE every 6 months
- Advantage: Avoids immediate morbidity associated with treatment
- Disadvantage: Risk of disease complications such as urinary retention or fractures
Active surveillance:
- Based on premise that prostate cancer is a benign and indolent disease
- Involves active monitoring of disease. If cancer noted to progress, will initiate potentially ___ therapy
- Advantage: QOL less affected
- Disadvantage: 1/3 of patients require treatment, follow ups/biopsies
- symptoms
- curative
Treatment Overview: Localized
Radiation therapy
- External beam vs. brachytherapy
- Reasonable alternative to patients who are not ___ candidates
- Can add adjuvant ___ if intermediate or poor risk
- start prior to radiation therapy
and then continue on for 1-3 years
- surgical
- ADT
androgen deprivation therapy
Treatment: Localized
Radical prostatectomy + PLND
- Definitive ___ therapy
- survival with surgery: ~ 85% at 10 years
curative
PLND = Pelvic lymph node dissection
Androgen Deprivation Therapy
Goal is to induce ___ levels of testosterone
- Goal level = < __ ng/dL after 1 month of therapy
Androgen deprivation therapy (ADT)
- ___ agonist ± ___ or orchiectomy
castrate
50
LHRH, anti-androgen
Antiandrogens
- Blocks androgen receptors and inhibits androgen uptake and binding in target tissues
examples:
- Bicalutamide, Nilutamide, Flutamide, ___ , ___
- In the metastatic setting, not generally given as monotherapy
- Will give in combination with androgen ablation therapy such as LHRH agonist in the metastatic setting
Abiraterone, Enzalutamide
lutamides
Androgen Deprivation Therapy
LHRH agonists
- ___ and is as effective as orchiectomy
examples
- leuprolide, goserelin, triptorelin, histerelin
Toxicities:
– Acute: Tumor ___ (in the metastatic setting), ___, hot flashes, erectile dysfunction, edema, injection site reaction
- Long term: ___ , fracture, obesity, insulin resistance, changes in ___ , increased risk of both ___
and cardiovascular events
- reversible
- flare, gynecomastia
- osteoporosis, lipids, diabetes
Relugolix - Compared to LHRH agonists, had less cardiovascular events
Metastatic Disease
Goal of therapy – ___ of disease
- Need to determine whether this is a PSA recurrence or overt metastatic disease
- Determine PSA ___ time
- palliation
- doubling
Metastatic Disease: m0 HSPC
If only PSA recurrence, may delay start of ___
If the patient experiences a rapid PSA
velocity or ___ PSA doubling time and has a long-life expectancy: Consider ___
* If PSA doubling time ___ 6 months: Can give ADT
* If PSA doubling time ___6 months: can observe
Orchiectomy
- ADT
- short, ADT
- <
- >
Intermittent ADT: m 0 HSPC
Can start on LHRH agonist alone or with oral ADT
- When the PSA level has returned to a pre-specified baseline (i.e., 4 ng/dL), androgen suppression is ___
- restarted if PSA increases (10-20 ng/dL)
- d/c
Darolutamide
- Structurally ___ androgen receptor antagonist
- Offers potentially less toxicities and less severe toxicities (Less fractures, falls, seizures, weight loss)
- Drug interactions: Mainly metabolized through CYP ___
- Toxicities: Fatigue, back pain/arthralgias, rash, diarrhea,
hypertension, anemia, nausea
- unique
- CYP3A4
m1CRPC
In addition to continuing ___ therapy, the patient could do any of the following:
- ADT
___ -Second line therapy
- Taxane derivative (Microtubule inhibitor)
- Unlike other taxanes. Poor affinity for ___ proteins, therefore conferring activity in resistant tumors
- Toxicities: More severe ___, more
___ , more febrile neutropenia
Cabazitaxel
- neutropenia
- diarrhea
Treatment Summary
