Prostate Cancer and screening

Question 1

Leuprolide is used to treat

Answer 1

metastatic prostate cancer (it’s form of androgen deprivation therapy) can used with castrate resistant prostate cancer

Question 2

What type of chemotherapy is used to treat prostate cancer?

Answer 2

taxanes

Question 3

Treatment of bone pain and delaying pathological fractures in patients with castrate resistant prostate cancer and bone metastasis

Answer 3

parenteral bisphosphonates (pamidronate)

Question 4

What to consider before giving pamidronate?

Answer 4

renal function.

Question 5

most common side effect of radiation treatment for localized prostate cancer

Answer 5

sexual dysfunction - radiation damages the nerve.

up to 45% of men become impotent after therapy and frequency increases with time.

Increased risk with androgen deprivation therapy is added to radiation therapy.

Risk of impotence is reduced if avoiding radiation to penile structures.

Question 6

what can help with sexual dysfunction related to radiation therapy from prostate cancer?

Answer 6

phosphodiesterase inhibitors (sildenafil) may help

Question 7

secondary cancers from radiation therapy for prostate cancer?

Answer 7

exact risk is difficult to assess because studies didn’t account for factors like concurrent smoking but see bladder and rectal cancers.

Question 8

other temporary side effects of radiation therapy related to prostate cancer?

Answer 8

urinary frequency and dysuria in 50% of pts but this occurred during treatment with external beam radiation but symptoms resolved within a few weeks of therapy completion. Rarely is there strictures and bladder contractures or cystitis.

Question 9

transrectal ultrasound for guided prostate biopsy is recommended in

Answer 9

all men with prostatic nodules regardless if PSA value is low or without symptoms.

Question 10

how is it transrectal ultrasound prostate biopsy done?

Answer 10

given antibiotics prior to procedure and done at urologists office can assess volume in addition improve bipsy results.

Question 11

endorectal coil MRI is done

Answer 11

with TRUS (transrectal U/S) to better visual seminal vesicle involvement or extraprostatic extension of localized prostate cancer. Helped to look at staging for KNOWN prostate cancer.

Question 12

indications for transrectal U/S prostate biopsy

Answer 12

Question 13

when to get repeat transrectal prostate biopsy?

Answer 13

inadequate sample size on initial biopsy

continued high clinical suspicion based on high PSA serum and symptoms

abnormal histology on initial biopsy - atypical small acinar proliferation

Question 14

side effect of radical prostectomy?

Answer 14

urinary incontinence and due to urethral sphinter injury

• can see 50% of pts develop stress incontinence within 2 months of surgery and incidence dramatically decreases by 10% by 2 years after surgery

treat with nonsurgical solution and do pelvic floor exercises with biofeedback.

if fail this can get surgery with artificial sphincter placement or sling procedure

Question 15

treatment of ED after radical prostatectomy?

Answer 15

sildenafil can improve ED.

Question 16

Treatment of prostate cancer is divided into four categories:

Answer 16

observation, active surveillance, and TREATMENT: radiation or radical prostatectomy

observation = watch meant for men with limited life expectancy and significant medical cormorbidities

active surveillance - deferral of curative intent therapy in lieu of regular monitoring for evidence of dx progression. Option for very low risk or low risk prostate cancer with a life expectancy >10 years

Active treatment is for low risk localized prostate cancer, with radiation or radical prostectomy

radiation - low risk localized prostate cancer = external beam radiation or brachytherapy

radical prostectomy remove the prostate

Question 17

active surveillance of prostate cancer is:

Answer 17

digital rectal exam q12 months

serial serum PSA - if PSA doubles in 3 years need to treat

repeat biopsy is done at 1 year and if no high grade dx then biopsy can be done less often

15 year survival is 97% in selected pts.

Question 18

most common side effect of radiation treatment of prostate cancer?

Answer 18

short term risk: enteritis and cystitis

ED increases over time with 60-70% of pts have ED by 2 years.

Question 19

most common side effects of radical prostectomy

Answer 19

immediately after: urinary incontinence; long term only 5-10%

ED more common and persists for years with 40% of pts at 2 years with ED

Question 20

pts who have intermediate or high risk localized dx are treated wtih

Answer 20

radiation therapy and GnRH agonist to delay dx progression.

Question 21

pts who have high risk or very high risk prostate cancer get:

Answer 21

six cycles of docetaxel after radiation in addition to androgen deprivation therapy which improves dx free survival and overall survival.