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Oncology Exam 3 > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Median age of onset for prostate cancer

A

66 years

rare <40

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2
Q

T/f there is an increased incidence in and reduced survival in prostate cancer in Caucasians

A

false!

African Americans

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3
Q

Etiology of prostate cancer

A
  • genetics
  • high fat diet
  • BPH?
  • vasectomy?
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4
Q

What is the growth signal for prostate cancer?

A

testosterone

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5
Q

What converts testosterone to dihydrotestosterone?

A

5a reductase

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6
Q

What 3 things are associated with high fat diet/obesity in prostate cancer?

A
  1. IGF-1
  2. Testosterone levels
  3. Inflammation
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7
Q

Screening for prostate cancer

A
  1. DRE: fairly good

2. PSA: a hot mess!

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8
Q

t/f rock hard prostate with DRE is indictive of cancer

A

true

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9
Q

PSA >10

A

more likely to be cancer

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10
Q

t/f always biopsy in prostate cancer

A

false!

It is harder to get to!

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11
Q

What is prognosis related to in prostate cancer?

A
  1. grade
  2. tumor size
  3. invasion
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12
Q

Gleason score

A

Used in prostate cancer
Measures level of differentiation and growth pattern
*add 2 scores together

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13
Q

Gleason score = 6

A 
well differentiated (more like normal prostate tissue)
*good prognosis/low risk
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14
Q

Gleason score 7

A

moderately differentiated

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15
Q

Gleason score 8-10

A

poorly differentiated

* poor prognosis/high risk

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16
Q

Staging in prostate cancer

A

Local stage
Regional stage
Distant stage

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17
Q

T/F gene testing is incorporated into NCCN guidelines for prostate cancer

A

False!

Not yet, but soon!

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18
Q

What drug class is used for chemoprevention in prostate cancer?

A

ARI (5 alpha reductase inhibitors)

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19
Q

Main ADE of ARIs

A

sexual dysfunction!

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20
Q

T/F ARIs are good for high grade prostate tumors in chemoprevention

A

False!

Only good in low grade group

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21
Q

T/f non-traditional chemopreventative therapies for prostate cancer can be used

A

false!

SERMS, vitamin E, selenium, metformin, cox2 inhibitors, statins, vitamin D, green tea, lycopene = no role!

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22
Q

Stage I prostate cancer treatment overview

A 
ww = esp in elderly
as/am
radical prostatectomy = younger men
EBRT
brachytherapy
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23
Q

Stage II prostate cancer treatment overview

A

ww/as/am
Radical prostecotmy
EBRT w/wo hormone therapy ***testosterone deprivation
Brachytherapy

24
Q

Stage III prostate cancer treatment overview

A

EBRT +/- hormone therapy
Hormone +/- radiation
Radical prostectomy +- EBRT
WW/as/am

25
Q

Stage IV prostate cancer treatment overview

A

Hormone therapy
Bisphos
EBRT +/- hormone therapy
Palliative radiation

26
Q

Very low risk/low risk prostate cancer

A

Low stage
Gleason = 6
PSA <10

27
Q

Intermediate risk prostate cancer

A

lower stage
gleason score 7
PSA 10-20

28
Q

High risk prostate cancer

A

Early stage 3 disease
Gleason 8-10
PSA >10

29
Q

Very high risk prostate cancer

A

Stage 3 to early 4

Gleason 8-10

30
Q

Standard of care nodal and metastatic prostate cancer

A

ADT + abiraterone + prednisone

31
Q

Radical prostatectomy

A

cures 80-90% of men

*incontinence and impotence

32
Q

T/F orchiectomy immediately drops testosterone and is highly used

A

false!
Not acceptable in US
Ok in europe

33
Q

ADT options

A

Orchiectomy
LHRH agonists
LHRH antagonists

34
Q

LHRH agonists

A

Leuprolide
Goserelin
Triptorelin
Must use antiandrogens to prevent tumor flare

35
Q

LHRH antagonists

A

Degarelix

Do NOT have to use antiandrogens*

36
Q

T/F LHRH agonists are not equivalent

A

false!

ARE equivalent

37
Q

Main antiandrogen used

A

bicalutamide

38
Q

Antiandrogen use

A

prevent tumor flare

combined with LHRH agonists

39
Q

LHRH agonist ADEs

A 
Hot flashes
CVD
Metabolic syndrome
Osteoporosis
Tumor flare
Gynecomastia
Sex dysfcn
40
Q

Antiandrogen ADEs

A

GI: diarrhea Flut > bicalut
Hot flashes
Gynecomastia
Liver tox: rare, but serious

41
Q

CAB

A

LHRH agonist + antiandrogen

42
Q

Why is CAB therapy not upfront therapy?

A

cost and toxicity

43
Q

Case: patient newly on LHFH agonist + antiandrogen. do they remain on CAB?

A

no!
only stay on for 1st few weeks then take off!
you will see tumor flare most likely in first few weeks

44
Q

2nd line therapy for LA/MD prostate cancer

A

Antiandrogen withdrawal

Ketoconazole

45
Q

Why is ketoconazole not upfront therapy in prostate cancer?

A 
High toxicity
*hepatitis
*Need hydrocortisone replacement
DDIs
Expensive
46
Q

T/F all patients placed on ADT will ultimately become refractory

A

true!

47
Q

Immunotherapy (Sipuleucel) in CRPC (castrate resistant prostate cancer)

A

Needs to have good performance status!

Usual response measures not useful

48
Q

Standard of care in CRPC

A

Docetaxel + prednisone

*dose intensity

49
Q

When is cabazitaxel used in prostate cancer?

A

CRPC if not responding to docetaxel + prednisone

50
Q

Premed with cabazitaxel

A 
H1, H2, steroids
Profound neutropenia (esp elderly)
51
Q

Salvage therapy in CRPC

A

Abiraterone + prednisone

Enzalutamide (more potent antiandrogen than bicalutamide)

52
Q

Radium in prostate cancer

A

short linear path = alpha

good for pain and treatment

53
Q

Strontium in prostate cancer

A

longer path length = beta
good for pain
*myelosuppression

54
Q

Bone mets in prostate cancer

A

Radium, strontinum
Zolendronic acid
Denosumab

55
Q

Who can get radical proctectomy?

A

> 10 year life expectancy!

Not for older men!

Oncology Exam 3 (6 decks)

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