Prostate cancer Flashcards
Prostate cancer is dependent on what
Hormones!
Testosterone and DHT signal growth to the prostate
Prostate cancer risk factors
old age
African americans
family history
Prostate cancer screening
Digital rectal exam PSA (norm <4) Begin at age 50 unless high risk screened annually or every 2 years don't screen if <10 yrs life
<10 yrs life treatment
surveillance
tx if PSA rises or symptoms
Goal serum testosterone
<20-50 mg/dl
LHRH agonists moa
constant LHRH receptor activations downregulates production of LH and FSH and testost
as effective as castration. May cause initial disease flare
LHRH antagonists
aka GnRH antagonists moa
+agent
blocks GnRH receptors in pituitary to suppress FSH and LH and testost production. Don’t have a flare. Better for high tumor burden
-Degarelix
Combined androgen blockage CAB
orchiectomy or LHRH agonist combined with antiandrogen
LHRH agonist agents
injections Leuprolide Goserelin Triptorelin Histrelin
Antiandrogen agents
Bicalutamide PO cause diarrhea used with LHRH agonists Nilutamide=disulfiram like rxn + visual disturbances flutamide=more diarrhea
Side effects from anti-androgen therapy
sex dysfunction, gynecomastia, obesity, osteoporosis, hot flashes, hyperlipidemia
stage 1 and 2 prostate treatment
mainly surveillance
possible surgery
possible radiation
possible androgen deprivation therapy
Stage 3 prostate treatment
Radiation, years of ADT
possible surgery
Stage 4 prostate treatment
ADT
Castration resistant (CRPC)
progress even if testost levels are I goal with ADT
Continue LHRH ag/antag
consider 2nd line hormonal therapy, chemo, or immunotherapy
Abiraterone
preferred
PO
give with prednisone to reduce hypokal, fluid retention, edema, and HTN
androgen synthesis inh (cyp17). Very potent!
Lot of interactions tho
Enzalutamide
preferred
PO. Pure androgen receptor antagonist
Lowers seizure threshold
Ketoconazole
Nonselective cyp17 inhibitior, inhibits androgen syn in testes and andrenal gland.
PO. Naus/vomit, gynecomastia, elevated LFTs
Docetaxel for prostate
preferred
preferred in high volume diagnosis with visceral mets
Premedicate with antihistamine and steroids
every 3 weeks+prednisone bid
Cabazitaxel
preferred for 2nd line
approved for metastatic castration res prostate cancer only after failing docetaxel
Every 3 weeks. Prednisone
BBW: neutropenic deaths and hypersens so give premeds and growth factor
Sipuleucel-T
Provenge
company makes cells with prostatic acid phosphatase antigen
Metatstatic prostate algorithm
- Abiraterone, enzalutamide, or docetaxel
stop then start
- Abiraterone, enzalutamide, or docetaxel, or cabazitaxel(if resistant to docetaxel)
