Prostate cancer - Advanced Flashcards
Ancillary aspects of initial advanced prostate cancer care
Optimize pain control and symptom support
Engage with patient advocacy
Suspected advanced prostate cancer but no tissue - first step
get tissue (primary or met site)
BCR definition
PSA 0.2ng/mL twice after RP
nadir + 2 following radiation
What DNA testing can be useful for advanced CaP
MMR (mismatch repair) to assess for PARP inhibitor or PD1/PDL1 treatment
Who should be imaged after PSA recurrence following local therapy?
PSADT <12 months or high risk for met development
-Use PSMA PET or perhaps CT/bone scan or MRI
Options for patient with rising PSA after failure of local therapy and no mets on imaging
Observation strongly preferred
Intermittent ADT is acceptable
Definition of high volume met disease
4+ bone meta with at least one outside pelvis/spine OR visceral mets
What should be discussed or offered for mHSPC
genetic testing and counseling
mHSPC treatment options
ADT with LHRH agonists (lupron or goserelin) or antagonists (degarelix)
Surgical castration
abi+pred, apa, enza
docetaxel
ADT+doce+abipred/daro
Primary radiotherapy to prostate + ADT (low volume mHSPC)
How does docetaxel work?
inhibits microtubules
abiraterone mechanism
CYP17A1 inhibitor (also inhibits extragonadal androgen synthesis)
apalutamide mechanism
inhibits nuclear AR translocation
enzalutamide mechanism
Androgen receptor competitive inhibitor
Should bicalutamide be offered in conjunction with LHRH agonists?
Only to block flare
Do abipred/enxa/apa/daro need ADT too?
Yep
