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
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
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
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