Prostate Cancer Flashcards by BJ Jar

RFs for prostate cancer

65+ yrs old
BRCA-1/2
Scandanavian/US
Father/Brother
High Fat Diet
Smoking increases mortality
 -not incidence

How well did you know this?

Not at all

Perfectly

95% of prostate cancers are

Adenocarcinomas

How well did you know this?

Not at all

Perfectly

Survival of prostate cancer

100% if local

30% if distant dz

How well did you know this?

Not at all

Perfectly

Prevalence of prostate cancer

median 68 yrs old

up to 50% of men over 50

How well did you know this?

Not at all

Perfectly

Tx goal for early stage prostate cancer

Block androgens
-tumor regression
In adv stage, becomes hormone refractory/castration resistant/androgen independent

How well did you know this?

Not at all

Perfectly

When should you start screening for prostate cancer?

If over 50 or 
 over 45 if
   -AA
   -1st degree relative w/PC under 65
PSA +/- DRE

How well did you know this?

Not at all

Perfectly

PSA level to start discussing therapy

If PSA is 3 or greater,
 discuss chemo prevention
  -dutasteride/finasteride
     -if dev cancer, more aggressive
     -25% less incidence, more aggressive

How well did you know this?

Not at all

Perfectly

Gleason Score

Two specimens (1-5) added.
4 or less = well diff (slow)
5-6 = mod diff
7+ = poor diff (rapid)

How well did you know this?

Not at all

Perfectly

DRE

Specific
Safe
Insensitive
Inter-observer variability

How well did you know this?

Not at all

Perfectly

PSA

Simple, but not specific
Goal is less than 4
Can not tell BPH from PC if 4-10
Also look at velocity

How well did you know this?

Not at all

Perfectly

Clinical presentation of Localized PC

Asymptomatic

How well did you know this?

Not at all

Perfectly

Clinical presentation of Locally Invasive PC

Urinary dysfx
impotence
painful ejaculation

How well did you know this?

Not at all

Perfectly

Clinical presentation of Advanced PC

*BONE PAIN
BACK PAIN
Cord compression
Edema in lower extremities
Anemia
Wt loss
pathologic fractures

How well did you know this?

Not at all

Perfectly

Common mets for PC

skeletal

-Lumbar spine is most common distant spread

How well did you know this?

Not at all

Perfectly

Dgx of PC

DRE
PSA (TRUS of elevated)
Biopsy - Staging

How well did you know this?

Not at all

Perfectly

Stages of PC that req pharm tx

Only in meta or locally advanced dz

How well did you know this?

Not at all

Perfectly

After discussing screening, those who choose to screen who have a PSA above ___ should:

Above 2.5
should be tested annually
with PSA +/- DRE

Prognosis depends on

Gleason Score (best)
Tumor Size
Local Extent of dx

Tx options for PC

1 Expectant mgmt
   -PSA +/- DRE q 6mo
2 Surgery
   -Orchiectomy or radical prostatectomy
3 Radiation Tx
   -EBRT
   -Brachytherapy (implant)
4 Pharm Tx
   -Andro Dep Tx (ADT)
   -Chemo
   -Immunosuppression

Tx Options for Castration Resistant PC

Chemotherapy

Immunotherapy

ADT

Androgen Deprivation Therapy
 -used for locally advanced / meta PC
LHRH
GnRH
Antiandrogens
Androgen Synthesis Inhibitors
 -newer agents used for cast. resist. PC

Initial Tx options for localized PC

Active surveillance
EBRT or Brachytherapy
RP (+/- PLND)
Observation

Initial Tx for Locally Advanced PC

EBRT + ADT for 2-3 yrs

Initial Tx for Meta PC

If not M1, EBRT + ADT

Once M1, only ADT

___ is the gold standard for men with metastatic PC

ADT

ADT options for Advanced PC

``` Orchiectomy LHRH agonists +/- antiandrogen 7+ days to prevent testosterone flare LHRH agonists alone Continuous ADT and Docetaxel ```

LHRH agonists

Leuprolide, goserelin, triptoelin - lower LH/FSH which lowers T * *ADE = TUMOR FLARE, bone density * **(give antiandrogens x2 wks) * *Supp w/ 500 Ca and 400 Vit D

GnRH Antagonists

``` Degarelix -lower LH/FSH which lowers T ADE - bone mineral density Supp w/500 Ca and 400 Vit D Due to ALL, restricted access ```

Antiandrogens

Flutamide, bicalutamide, nilutamide Ind in META-PC W/ LHRH agonists -prevent TUMOR FLARE from LHRH

CRPC

Cast Resist PC Dz progresses during ADT AND at least 4 wks after withdrawal of ADT

Tx for CRPC with NO visceral mets

Abiraterone + Pred Enzalutamide Docetaxel + Pred Radium-223

Tx for CRPC with Visceral Mets

Enzalutamide | Docetaxel + Pred

Sipuleucel-T

``` Immunotherapy for mCRPC Must have: -ECOG score 2 or less -Est. life expectancy over 6 mo -No visceral dz (no organ involvement) -Minimal symptoms B/C very expensive process Uses pts own immune sys to fight ```

Abiraterone

``` ADT Inhibits T synthesis -inhibits CYP17 ADEs: -mineral cort excess (hypoK, HTN, fluid retention) -adrenal cort insufficiency PC -EMPTY STOMACH -Take w/prednisone 5 BID to reduce MCE and ADI ```

Enzalutamide

ADT Pure Androgen Receptor Antagonist -can be used alone

PC for Abiraterone

EMPTY STOMACH Take with Prednisone -to prevent MCE and ADI

Use of chemo in PC

Reserved for mCRPC Docetacel q3wks +/- Pred Cabazitaxel is 2nd line

Docetaxel

Preferred 1st line chemo for mCRPC | Cabazitaxel is 2nd line

Supportive therapy for mCRPC

``` Prevent Skeletal Related Events (SREs) Bisphosphonates -zolidronic acid or pamidronate Denosumab ```

Zolidronic acid vs denosumab

Both used for supportive tx in mCRPC -to prevent Skeletal Related Events (SRE) ***ZA must be renally adjusted ***Both have ADE of osteonecrosis of jaw