Prostate Cancer Flashcards
Median age of onset for prostate cancer
66 years
rare <40
T/f there is an increased incidence in and reduced survival in prostate cancer in Caucasians
false!
African Americans
Etiology of prostate cancer
- genetics
- high fat diet
- BPH?
- vasectomy?
What is the growth signal for prostate cancer?
testosterone
What converts testosterone to dihydrotestosterone?
5a reductase
What 3 things are associated with high fat diet/obesity in prostate cancer?
- IGF-1
- Testosterone levels
- Inflammation
Screening for prostate cancer
- DRE: fairly good
2. PSA: a hot mess!
t/f rock hard prostate with DRE is indictive of cancer
true
PSA >10
more likely to be cancer
t/f always biopsy in prostate cancer
false!
It is harder to get to!
What is prognosis related to in prostate cancer?
- grade
- tumor size
- invasion
Gleason score
Used in prostate cancer
Measures level of differentiation and growth pattern
*add 2 scores together
Gleason score = 6
well differentiated (more like normal prostate tissue) *good prognosis/low risk
Gleason score 7
moderately differentiated
Gleason score 8-10
poorly differentiated
* poor prognosis/high risk
Staging in prostate cancer
Local stage
Regional stage
Distant stage
T/F gene testing is incorporated into NCCN guidelines for prostate cancer
False!
Not yet, but soon!
What drug class is used for chemoprevention in prostate cancer?
ARI (5 alpha reductase inhibitors)
Main ADE of ARIs
sexual dysfunction!
T/F ARIs are good for high grade prostate tumors in chemoprevention
False!
Only good in low grade group
T/f non-traditional chemopreventative therapies for prostate cancer can be used
false!
SERMS, vitamin E, selenium, metformin, cox2 inhibitors, statins, vitamin D, green tea, lycopene = no role!
Stage I prostate cancer treatment overview
ww = esp in elderly as/am radical prostatectomy = younger men EBRT brachytherapy
Stage II prostate cancer treatment overview
ww/as/am
Radical prostecotmy
EBRT w/wo hormone therapy ***testosterone deprivation
Brachytherapy
Stage III prostate cancer treatment overview
EBRT +/- hormone therapy
Hormone +/- radiation
Radical prostectomy +- EBRT
WW/as/am
Stage IV prostate cancer treatment overview
Hormone therapy
Bisphos
EBRT +/- hormone therapy
Palliative radiation
Very low risk/low risk prostate cancer
Low stage
Gleason = 6
PSA <10
Intermediate risk prostate cancer
lower stage
gleason score 7
PSA 10-20
High risk prostate cancer
Early stage 3 disease
Gleason 8-10
PSA >10
Very high risk prostate cancer
Stage 3 to early 4
Gleason 8-10
Standard of care nodal and metastatic prostate cancer
ADT + abiraterone + prednisone
Radical prostatectomy
cures 80-90% of men
*incontinence and impotence
T/F orchiectomy immediately drops testosterone and is highly used
false!
Not acceptable in US
Ok in europe
ADT options
Orchiectomy
LHRH agonists
LHRH antagonists
LHRH agonists
Leuprolide
Goserelin
Triptorelin
Must use antiandrogens to prevent tumor flare
LHRH antagonists
Degarelix
Do NOT have to use antiandrogens*
T/F LHRH agonists are not equivalent
false!
ARE equivalent
Main antiandrogen used
bicalutamide
Antiandrogen use
prevent tumor flare
combined with LHRH agonists
LHRH agonist ADEs
Hot flashes CVD Metabolic syndrome Osteoporosis Tumor flare Gynecomastia Sex dysfcn
Antiandrogen ADEs
GI: diarrhea Flut > bicalut
Hot flashes
Gynecomastia
Liver tox: rare, but serious
CAB
LHRH agonist + antiandrogen
Why is CAB therapy not upfront therapy?
cost and toxicity
Case: patient newly on LHFH agonist + antiandrogen. do they remain on CAB?
no!
only stay on for 1st few weeks then take off!
you will see tumor flare most likely in first few weeks
2nd line therapy for LA/MD prostate cancer
Antiandrogen withdrawal
Ketoconazole
Why is ketoconazole not upfront therapy in prostate cancer?
High toxicity *hepatitis *Need hydrocortisone replacement DDIs Expensive
T/F all patients placed on ADT will ultimately become refractory
true!
Immunotherapy (Sipuleucel) in CRPC (castrate resistant prostate cancer)
Needs to have good performance status!
Usual response measures not useful
Standard of care in CRPC
Docetaxel + prednisone
*dose intensity
When is cabazitaxel used in prostate cancer?
CRPC if not responding to docetaxel + prednisone
Premed with cabazitaxel
H1, H2, steroids Profound neutropenia (esp elderly)
Salvage therapy in CRPC
Abiraterone + prednisone
Enzalutamide (more potent antiandrogen than bicalutamide)
Radium in prostate cancer
short linear path = alpha
good for pain and treatment
Strontium in prostate cancer
longer path length = beta
good for pain
*myelosuppression
Bone mets in prostate cancer
Radium, strontinum
Zolendronic acid
Denosumab
Who can get radical proctectomy?
> 10 year life expectancy!
Not for older men!
