Prostate Cancer

Question 1

What are the high risk features of prostate cancer?

Answer 1

Gleason > or = 8
PSA > 20
Tumour Extent > or = T3 (extends through the prostate capsule).

Question 2

What is the work up for prostate cancer?

Answer 2

Exam, prostate biopsy, serum PSA

If symptomatic or “high-risk” then imaging with bone scan, CT chest/abdo/pelvis.

Question 3

What are the treatment options for early/localized prostate cancer (3)?

Answer 3

1. Active Surveillance (PSA monitoring)
2. Radical Prostatectomy +/- lymph node dissection
3. Radiation

Question 4

How is metastatic prostate cancer treated?

Answer 4

Androgen deprivation therapy AND a second agent.

1. ADT + chemotherapy w/Docetaxel
2. ADT + non-steroidal anti androgen (abiraterone)

Question 5

What are the androgen deprivation options in metastatic prostate cancer management?

Answer 5

GnRH agonist - Lupron

GnRH anatagonist - Degarelix

Question 6

What are the side effects of androgen deprivation therapy (5)?

Answer 6

Osteoporosis
Decreased Libido
Gynecomastia
Hot Flashes
Fatigue

Question 7

What other medications should ALL patients on androgen deprivation therapy be on, to mitigate side-effects?

Answer 7

Calcium
Vitamin D
Bisphosphonate for metastatic disease or low BMD