Prostate cancer

Question 1

Prostate cancer is dependent on what

Answer 1

Hormones!

Testosterone and DHT signal growth to the prostate

Question 2

Prostate cancer risk factors

Answer 2

old age
African americans
family history

Question 3

Prostate cancer screening

Answer 3

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

Question 4

<10 yrs life treatment

Answer 4

surveillance

tx if PSA rises or symptoms

Question 5

Goal serum testosterone

Answer 5

<20-50 mg/dl

Question 6

LHRH agonists moa

Answer 6

constant LHRH receptor activations downregulates production of LH and FSH and testost

as effective as castration. May cause initial disease flare

Question 7

LHRH antagonists
aka GnRH antagonists moa
+agent

Answer 7

blocks GnRH receptors in pituitary to suppress FSH and LH and testost production. Don’t have a flare. Better for high tumor burden
-Degarelix

Question 8

Combined androgen blockage CAB

Answer 8

orchiectomy or LHRH agonist combined with antiandrogen

Question 9

LHRH agonist agents

Answer 9

injections
Leuprolide
Goserelin
Triptorelin
Histrelin

Question 10

Antiandrogen agents

Answer 10

Bicalutamide
PO
cause diarrhea
used with LHRH agonists
Nilutamide=disulfiram like rxn + visual disturbances
flutamide=more diarrhea

Question 11

Side effects from anti-androgen therapy

Answer 11

sex dysfunction, gynecomastia, obesity, osteoporosis, hot flashes, hyperlipidemia

Question 12

stage 1 and 2 prostate treatment

Answer 12

mainly surveillance
possible surgery
possible radiation
possible androgen deprivation therapy

Question 13

Stage 3 prostate treatment

Answer 13

Radiation, years of ADT

possible surgery

Question 14

Stage 4 prostate treatment

Answer 14

ADT

Question 15

Castration resistant (CRPC)

Answer 15

progress even if testost levels are I goal with ADT
Continue LHRH ag/antag
consider 2nd line hormonal therapy, chemo, or immunotherapy

Question 16

Abiraterone

preferred

Answer 16

PO
give with prednisone to reduce hypokal, fluid retention, edema, and HTN
androgen synthesis inh (cyp17). Very potent!
Lot of interactions tho

Question 17

Enzalutamide

preferred

Answer 17

PO. Pure androgen receptor antagonist

Lowers seizure threshold

Question 18

Ketoconazole

Answer 18

Nonselective cyp17 inhibitior, inhibits androgen syn in testes and andrenal gland.
PO. Naus/vomit, gynecomastia, elevated LFTs

Question 19

Docetaxel for prostate

preferred

Answer 19

preferred in high volume diagnosis with visceral mets
Premedicate with antihistamine and steroids
every 3 weeks+prednisone bid

Question 20

Cabazitaxel

preferred for 2nd line

Answer 20

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

Question 21

Sipuleucel-T

Provenge

Answer 21

company makes cells with prostatic acid phosphatase antigen

Question 22

Metatstatic prostate algorithm

Answer 22

1. Abiraterone, enzalutamide, or docetaxel

stop then start

2. Abiraterone, enzalutamide, or docetaxel, or cabazitaxel(if resistant to docetaxel)