Prostate Cancer

Question 1

Risk factors for Prostate ca

Answer 1

Age (>50)
Ethnicity
Family hx
Genes
Diet high in fat
Obesity
Vasectomy

Question 2

Screening recommendations for prostate ca

Answer 2

PSA and DRE >50yrs
High risk start at 40-45yrs
NOT recommended in men >70, life expectancy

Question 3

What are two PSA markers?

Answer 3

PCA 3

Proenzyme PSA

Question 4

Signs and symptoms of prostate ca

Answer 4

Urinary symptoms
Abnormal DRE or elevated PSA
Worsening symptoms with advanced disease

Question 5

Gold standard of diagnosis for prostate ca

Answer 5

Prostate biopsy

Question 6

What is considered low risk prostate ca?

Answer 6

A Gleason score of less than or equal to 6 with a PSA of 10

Question 7

What is intermediate risk prostate ca?

Answer 7

PSA 10-20 and Gleason of 7

Question 8

What is high risk prostate ca?

Answer 8

PSA >20 and Gleason of 8-10

Question 9

What is the most common type of prostate cancer?

Answer 9

Adenocarcinoma at 90%

Question 10

Surveillance methods for low risk prostate ca

Answer 10

PSA q3-6mo

Annual DRE and bx

Question 11

When do you switch to active treatment of prostate ca?

Answer 11

Gleason score >7 on rpt bx
More positive samples
PSA doubling

Question 12

What is the gold standard for prostate surgery?

Answer 12

Robotic assisted surgery

Question 13

What is post treatment surveillance for prostate cancer?

Answer 13

Initial definitive therapy
-PSA Q6-12mo x5yrs, then q yr

N1 or M1
-physical exam with DRE and PSA q3-6mo

Question 14

What is treatment for high risk prostate ca?

Answer 14

XRT + Neoadjuvant ADT
OR
Radical prostatectomy with lymph node dissection

Question 15

What is the biological effect?

Answer 15

Period of time between the breaking of chemical bonds and expression of biological effect
-could be hours, days, months, years

Question 16

What is image guided radiation therapy?

Answer 16

Ultrasound used to detect prostate motion and delivers XRT when prostate is in field

Question 17

What is the tolerance dose?

Answer 17

Dose that produces acceptable probability of tx complication

-involves radiobiology, socioeconomic and psych factors

Question 18

What do androgens do?

Answer 18

Promote the development and progression of prostate cancer

Question 19

What is a LHRH Antagonist?

Answer 19

Stimulates release of LHRH
Stops testosterone production
*may have initial tumor flare
Ex: Lupron

Question 20

What is a LHRH Antagonist?

Answer 20

Suppresses LH production
Castrate level testosterone
*no tumor flare
Ex: Degarelix

Question 21

What are anti androgens?

Answer 21

Block absorption of testosterone into cells
Prevent tumor flare
Ex: casodex

Question 22

What are androgen synthesis inhibitors?

Answer 22

Inhibits testosterone and LH synthesis

Ex: Zytiga

Question 23

What is biochemical failure?

Answer 23

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

Question 24

What is treatment of biochemical failure?

Answer 24

Intermittent androgen blockade

Question 25

What is CRPC?

Answer 25

Disease from rising PSA w/o mets or symptoms despite ADT
OR
mets and debilitation from cancer symptoms

Question 26

Treatment for CRPC

Answer 26

Zytiga with prednisone

Question 27

What is immunotherapy vaccine for prostate ca?

Answer 27

Provenge

Done by pheresis using patients own cells

Question 28

Common sites of mets in prostate ca

Answer 28

Bone
Spine
Liver
Lung
Lymph nodes

Question 29

What is a rare but severe side affect of Zometa use?

Answer 29

Osteo necrosis of the jaw

Question 30

When is radium 223 chloride used?

Answer 30

Symptomatic bone mets without known visceral disease

-mimics calcium

Question 31

Incidence of Prostate Cancer

Answer 31

Most common cancer found in American men