Prostate Cancer Flashcards
Prostate Specific Antigen (PSA) blood test
- Normal range
- Closer monitor
- Suspicious for malignancy
- Normal range: 0-4 ng/mL
- Closer monitor: 2.5-4ng/mL
- Suspicious for malignancy > 10 ng/mL
- PSA > normal range, biopsy is performed to confirm diagnosis
Rec age for baseline PSA
- Men after age 40 y.o
Zoladex
- Form
- Dose
GOSerelin - GOE se rel in
- Form: SC
Dose
- 3.6 mg SC Q1M
- 10.8mg SC Q3M
Lupron
- Form
- Dose
Leuprolide - Loo PROE lide
- Form: IM
Dose:
- 7.5 mg IM Q1M
- 22.5 mg IM Q3M
- 30mg IM Q4M
Trelstar
- Form
- Dose
Triptorelin
Dose
- 3.75mg IM Q1M
- 11.25mg Q3M
LH-RH or GnRH stands for
Leutenizing hormone- Releasing hormones
Firmagon
- Form
- Dose
Degarelix
- Form: SC
- Dose: 80 mg SC Q28D
Plenaxis Depot
- Indication:
- Form:
- Dose
Abarelix
- Indication: palliative treatment in advanced sx PC
- Form: IM
- Dose: IM Q2W x 1M, then Q4W
Casodex
BIClutamide
Eulexin
FLUtamide
Nilandron
NILutamide
Xtandi
- Indications
Enzalutamide
- Indication: Prostate cancer not responding to other treatments
Zytiga
- Indication
Abiraterone - A bi ra ter one
- I: Used w/ prednisone in men with castration-resistant prostate cancer
Nizoral
- Indication:
Ketoconazole
- Prostate cancer Salvage Hormone Therapy (off-label)
Proscar
- Indication
Finasteride
Indication:
- BPH
- Prevention of prostate cancer risk
- Baldness
Avodart
- Indication:
Dutasteride
Indication:
- BPH
- Prevention of prostate cancer risk
Provenge
- Indication
Sipuleucel-T - si pu LOO sel
- I: tx advance PC
LH-RH analogs
- Drugs in this class
- MOA
- Other indications:
Goserelin - Zoladex
Leuprolide - Lupron
Triptorelin - Trelstar
- MOA: LH and FSH increase = increase testosterone => stop releasing LH & FSH.
- It works by negative feedback: First gets worse b/c there is a surge increase in testosterone then when negative feedback kicks in, it gets better
Indication
- Prostate cancer
- Endometriosis
- Pre-Menopausal hormone positive breast cancer
LH-RH analogs
- SEs
- How to prevent tumor flares
SEs
- Tumore flare: bone pain, inc tumor size, urinary sx
- Hot flashes, impotence, decr libido, decrease bone density, gynecomastia, pain @ injection site
- Ischemia 19%
- Thrombosis/PE/MI
- Peripheral edema 12%
Prevent tumor flares
- Use anti-androgen therapy
- Flutamide, Biclutamide, Nilutamide
- Starts 2-4 wks prior to LHRH agonist, continue 1 week after the start
LH-RH analogs
Route of administration
- Goseline - Zoladex
- Leuprolide - Lupron
- Triptorelin - Trelstar
Goseline - Zoladex
- 3.6 mg SC Q1m
- 10.8 mg SC 3mo, upper abdomen
Leuprolide - Lupron
- 7.5 mg IM Q1mo
- 22.5mg IM Q3mo
- 30 mg IM Q4mo
Triptorelin - Trelstar
- 3.75 mg IM Q1m
- 11.25 mg IM Q3m
Firmagon(R)
- MOA
- Route of administration
- SEs:
Degarelix
- MOA: LHRH antagonist => rapid suppression of testosterone and a rapid PSA reduction w/o the need for additional PO anti-androgen therapy
- Dose: 80 mg SC Q28D
SEs
- Hot flashes, wt gain, LFT elevation
Plenaxis Depot
- MOA
- Indication
- Route of Administration
Abarelix
- MOA: GnRH antagonist => Suppresses LH and FSH secretion thus reducing the secretion of testosterone from the testes. Direct inhibition of LH => no tumor flare
- Use as palliative tx in adv symptomatic prostate cancer in pts who are NOT candidate for LHRH agonists and refuse surgical castration
Dose
- 100 mg deep IM intragluteally Q2W x 1 mo
- Then Q4 wks thereafter
Anti-androgens
FLutamide - Eulexin
Biclutamide - Casodex
Nilutamide - Nilandron = night
Enzalutamide - Xtandi
- Special problems
Flutamide - Eulexin
- D: 250 mg Q8H
- SP: worse diarrhea, yellow green discoloration of urine, and liver dysfxn has been fatal
Biclutamide - Casodex
- D: 50mg QD
- SP: Interact w/ warfarin (protein binding) inc INR
- Diarrhea
Nilutamide - Nilandron
- D: 150 mg QD
- Do not drink EtOH = disulfiram rxn
- Diminished rx to darkness => cause delay adaption to the dark
- Constipation
Enzalutamide - Xtandi
- D: 160 mg PO QD
- SP: Sz
- SP: Avoid CYP3A4 and 2C8 inducers/inhibitors
Anti-androgens
- MOA
- Class SE
- Which cause diarrhea
- Which cause constipation
MOAs
- Block testosterone production
- Use w/ LHRH/GnRH analogues
SEs
- Gynecomastia, libido decr
- Hot flashes
- Liver enzyme increase => monitor LFT
Diarrhea
- Flutamide
- Biclutamide
Constipation
- Nilutamide
Zytiga
Xtandi
- Indication
Abiraterone - (PO)
Enzalutamide
- Prostate cancer not responding to other tx
- Used along with prednisone tx men w/ castration resistant prostate cancer (prostate cancer that is resistant to medical or surgical tx) that has spread to other parts of the body
Salvage Hormone Therapy
Nizoral
- MOA
- SEs
- DDI
Ketoconazole
- MOA: reduce levels of testosterone & cortisol
- SEs: haptic dysfxn, gynecomastia, N/V, rash
- DDI: requires acidic environment, inhibit 3A4 = lot of DDI
Proscar
Avodart
- Indication
- MOA
Finasteride
Dutasteride
- Indication: Use for PREVENTION of prostate cancer
- MOA: inhibits 5-alpha-reductase, the enzyme that converts testosterone to the more potent androgen dihydrostestosterone
Sipuleucel-T (Provenge)
- Indication
- Vaccine to tx advanced prostate cancer
- Use pt immune system to fight against the cancer
Eligard
Leuprolide Depot SC
Viadur
Leuprolide Implant 120mcg QD over 12 months
Lupaneta Pack
- Indications
Leuprolide deport IM + norethindrone oral tab
- Indications: endometriosis
