Prostate cancer

Question 1

What is life time risk of prostate cancer?

Answer 1

1/8

Question 2

How do you manage local prostate cancer?

Answer 2

Either surgical resection or Radiotherapy

Question 3

How do you manage Metastatic prostate cancer?

Answer 3

1. ADT + Docetaxal
2. If the cancer becomes castrate resistant, treat with Abiraterone or Enzalutamide
3. Treat bony disease - bisphosphonates or Denosumab

Question 4

What options are there for ADT?

Answer 4

1. Surgical orchidectomy
2. Medical Orchidectomy
   - GnRH agonist (Goserelin) + antiandrogen
   - GnRH antagonist (Degarelix)

Question 5

What are examples of anti-androgens?

Answer 5

Flutamide, biclutamide

Question 6

Name a GnRH antagonist?

Answer 6

Degarelix

Question 7

Name a GnRH agonist?

Answer 7

Goserelin

Question 8

How does Enzalutamide work ?

Answer 8

Binds to androgen receptor binding sites

Question 9

How does aberaterone work and what is the main side effect?

Answer 9

Inhibits CYP 17, causing inhibition of the enzyme 17 alpha hydroxylase and 17,20 lyase. These block pregnenolone and 17 alpha hydroxypregnenolone being converted to DHEA-s, and thus less testosterone.

Side effect is inhibition of 17 hydroxylase inhibits cortisol production. This in turn cause rise in ACTH. The rise in ACTH causes increased pregrenolone and increased aldosterone, and thus hypertension and hypokalaemia. Pred can stop the mineral corticoid insufficiency.

Question 10

How does sipuleucel T work ?

Answer 10

Dendritic cell vaccine, patients monocytes are harvested, exposed to prostatic acid and then infused back into the patient.
Increased progression free survival, but no change in PSA or progression free survival so is difficult to monitor.

Question 11

How does radium 223 work ?

Answer 11

Used only for bony mets, and no visceral disease.

It is chemically similar to calcium so is absorbed by bone, and then emits localised radiation to the surrounds bone.