Prostate Cancer Flashcards
Risk factors for Prostate ca
Age (>50) Ethnicity Family hx Genes Diet high in fat Obesity Vasectomy
Screening recommendations for prostate ca
PSA and DRE >50yrs
High risk start at 40-45yrs
NOT recommended in men >70, life expectancy
What are two PSA markers?
PCA 3
Proenzyme PSA
Signs and symptoms of prostate ca
Urinary symptoms
Abnormal DRE or elevated PSA
Worsening symptoms with advanced disease
Gold standard of diagnosis for prostate ca
Prostate biopsy
What is considered low risk prostate ca?
A Gleason score of less than or equal to 6 with a PSA of 10
What is intermediate risk prostate ca?
PSA 10-20 and Gleason of 7
What is high risk prostate ca?
PSA >20 and Gleason of 8-10
What is the most common type of prostate cancer?
Adenocarcinoma at 90%
Surveillance methods for low risk prostate ca
PSA q3-6mo
Annual DRE and bx
When do you switch to active treatment of prostate ca?
Gleason score >7 on rpt bx
More positive samples
PSA doubling
What is the gold standard for prostate surgery?
Robotic assisted surgery
What is post treatment surveillance for prostate cancer?
Initial definitive therapy
-PSA Q6-12mo x5yrs, then q yr
N1 or M1
-physical exam with DRE and PSA q3-6mo
What is treatment for high risk prostate ca?
XRT + Neoadjuvant ADT
OR
Radical prostatectomy with lymph node dissection
What is the biological effect?
Period of time between the breaking of chemical bonds and expression of biological effect
-could be hours, days, months, years
What is image guided radiation therapy?
Ultrasound used to detect prostate motion and delivers XRT when prostate is in field
What is the tolerance dose?
Dose that produces acceptable probability of tx complication
-involves radiobiology, socioeconomic and psych factors
What do androgens do?
Promote the development and progression of prostate cancer
What is a LHRH Antagonist?
Stimulates release of LHRH
Stops testosterone production
*may have initial tumor flare
Ex: Lupron
What is a LHRH Antagonist?
Suppresses LH production
Castrate level testosterone
*no tumor flare
Ex: Degarelix
What are anti androgens?
Block absorption of testosterone into cells
Prevent tumor flare
Ex: casodex
What are androgen synthesis inhibitors?
Inhibits testosterone and LH synthesis
Ex: Zytiga
What is biochemical failure?
Failure of PSA to fall to undetectable level
- After prostatectomy: PSA = or > 0.2 on two separate occasions
- After XRT: rise in PSA by 2 above nadir
What is treatment of biochemical failure?
Intermittent androgen blockade
What is CRPC?
Disease from rising PSA w/o mets or symptoms despite ADT
OR
mets and debilitation from cancer symptoms
Treatment for CRPC
Zytiga with prednisone
What is immunotherapy vaccine for prostate ca?
Provenge
Done by pheresis using patients own cells
Common sites of mets in prostate ca
Bone Spine Liver Lung Lymph nodes
What is a rare but severe side affect of Zometa use?
Osteo necrosis of the jaw
When is radium 223 chloride used?
Symptomatic bone mets without known visceral disease
-mimics calcium
Incidence of Prostate Cancer
Most common cancer found in American men
