Prostate Cancer Flashcards by Chelsea Luedtke

Median age of onset for prostate cancer

66 years

rare <40

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

false!

African Americans

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Etiology of prostate cancer

genetics
high fat diet
BPH?
vasectomy?

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What is the growth signal for prostate cancer?

testosterone

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What converts testosterone to dihydrotestosterone?

5a reductase

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

IGF-1
Testosterone levels
Inflammation

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Screening for prostate cancer

DRE: fairly good

2. PSA: a hot mess!

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

true

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PSA >10

more likely to be cancer

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t/f always biopsy in prostate cancer

false!

It is harder to get to!

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What is prognosis related to in prostate cancer?

grade
tumor size
invasion

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Gleason score

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

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Gleason score = 6

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

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Gleason score 7

moderately differentiated

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Gleason score 8-10

poorly differentiated

* poor prognosis/high risk

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Staging in prostate cancer

Local stage
Regional stage
Distant stage

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

False!

Not yet, but soon!

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What drug class is used for chemoprevention in prostate cancer?

ARI (5 alpha reductase inhibitors)

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Main ADE of ARIs

sexual dysfunction!

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

False!

Only good in low grade group

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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!

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Stage I prostate cancer treatment overview

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

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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!