Prostate Cancer 6 Flashcards

Recognize the indications for multimodal primary therapy and adjuvant therapy and evaluate the need andoptiosn for salvage therapy.

1
Q

What are the rates of progression of prostate cancer to advanced stages?

A
  • It takes approximately 8 to10 years for men to develop metastases after unsuccessful treatment of the primary tumor
    • depends on Gleason grade and PSA doubling time
  • With a rapid PSADT (3-6 months) metastases may become apparent within 2-5 years
  • In men with a rising PSA after androgen-deprivation therapy, the average time to bone metastases is 2 years and time to death is 4 years
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2
Q

What is androgen-deprivation therapy (ADT)?

A
  • Mainstay for treating advanced prostate cancer, because prostate cancer cells are stimulated to proliferate by the androgens produced by the testes, adrenal glands, and other body tissues, including the tumor
  • Frequently used as an adjuvant to radiotherapy in men with a high Gleason grade tumor
  • Androgenic stimulation can be largely eliminated by surgical or medical castration (LHRH agonists or antagonists)
  • The effects of extragonadal androgens can be substantially reduced with antiandrogens that block the androgen receptor, androgen biosynthesis inhibitors, and drugs that target the androgen receptor within the cell
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3
Q

What are some side effects of ADT?

A
  • Sexual dysfunction
  • Menopausal symptoms
  • Osteoporosis
  • Loss of energy
  • Possible increased risk for metabolic syndrome, diabetes, and cardiovascular disease
  • Although some prostate cancer patients have a long-term remission of disease, the tumor ultimately becomes “castrate resistant.”
    • ADT may be given intermittently to men who do not have metastases but should be given continuously to those with metastases
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4
Q

What are some methods of treating castrate-resistant prostate cancer?

A
  • Chemotherapy
    • docetaxel
    • cabazitaxel
  • Immunotherapy
    • sipuleucel-T
  • Alpha-particle emitting agents
    • radium-223
  • Expensive and clinical trials show a 4-month survival benefit
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