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Therapeutics IV > Prostate Cancer - Block 4 > Flashcards

Prostate Cancer - Block 4 Flashcards

1
Q

What are the risk factors of prostate cancer?

A
  1. ≥65YO
  2. African AMerican
  3. Family hx and mutations
  4. BPH can delay diagnosis
  5. Smoking doesn’t increases mortality
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2
Q

How do you screen for prostate cancer?

A

PSA is preferred methd

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3
Q

What is the general rec for screening?

A

Betwen 55-69, discuss with provider

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4
Q

What drugs can decrease PSA levels?

A

5-a reductase inhibitors, herbal supplements

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5
Q

What is the normal range of PSA?

A

≤4.0 ng/mL

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6
Q

Chances of acquiring prostate cancer from elevated PSA levels?

A

Borderline range: 4.1-10 ng/mL (25% chance)
Elevated range: >10 ng/mL (50% chance)

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7
Q

What are the presentations of localized prostate cancer?

A

Asymptomatic

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8
Q

What are the presentations of locally invasive prostate cancer?

A
  1. Ureteral dysfunction, frequency, hesitancy, dribbling
  2. Impotence
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9
Q

What are the presentations of advanced prostate cancer?

A
  1. Back pain
  2. Cord compression
  3. Lower extremity edema
  4. Pathologic fractures
  5. Anemia
  6. Weight loss
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10
Q

How do you diagnose prostate cancer?

A
  1. Diagnosed by PSA or DRE
  2. Followed by transrectal ultrasound (TRUS)
  3. Confirmed by biopsy
  4. Gleason score assigned
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11
Q

Characteristics of Stage I?

A

Small tumor load, not palpable nor visible by imaging

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12
Q

Characteristics of Stage II?

A

Tumor confined within prostate

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13
Q

Characteristics of Stage III?

A

Tumor extends through the prostate capsule

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14
Q

Characteristics of Stage IV?

A

Metastatic dx

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15
Q

What is used to deteremine the aggressiveness of prostate cancer?

A

Gleason Score

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16
Q

How do you interpret the Gleason score?

A

2 separate specimens:
* Scale of 1 (well differentiated) to 5 (poorly differentiated)
* Total: 2-4 (well), 5 or 6 (moderately), 7-10 (poorly)

  • Poorly differentiated grow faster (poor prognosis)
  • Well differentiated grow slower (better prognosis)
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17
Q

Initial prostate tx is based on what factors?

A
  1. Stage/size
  2. Gleason’s score
  3. PSA levels
  4. Presence of sx
  5. Life expectanct
  6. Co-morbitiies
  7. ADRs and pts preference
  8. Race
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18
Q

What are the types of initial tx?

A
  1. Active surveillance/observation
  2. Prostatectomy
  3. Radiation therapy +/- androgen deprivation therapy (ADT)
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19
Q

What are the characterisitcs of active surveillance?

A
  1. Monitoring cancer more closely
  2. Life expectancy ≥10 yrs
  3. PPSA q6 monthly
  4. DRE and biopsy yearly
  5. Progression -> curative tx
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20
Q

What are the characterisitcs of observation?

A
  1. Less intensive than follow up
  2. Life expectancy <10 yrs
  3. No biopsies, moniotring Q6-12 months
  4. Progression (sx) -> palliative tx
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21
Q

Indication for radical prostatectomy?

A

Reserved for patient with >10Y life expectancy and localized dx

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22
Q

What are the complications of radical prostatectomy?

A
  1. Blood loss
  2. Incontinence
  3. Anesthesia risk
  4. ED
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23
Q

What are the types of radiation therapy for prostate?

A
  1. External beam
  2. Brachytherapy
24
Q

What is external beam radiation therapy?

A
  1. Aims radiation at the tumor
  2. Based on availabiloity and duration
25
Q

What is bracytherapy?

A

Reserved for low risk -> places radiative seeds in or nearby tumor -> stays in body for months

26
Q

ADRs of radiation therapy?

A
  1. Cystitis
  2. Proctitis
  3. Hematuria
  4. Urinary retention
  5. Penoscrotal edema
  6. Impotence
27
Q

How long are ADT tx for high risk patients?

A

Long term: 2-3 yrs

28
Q

How long are ADT tx for intermediate risk patients?

A

Short term: 4-6 months

29
Q

What is the goal of ADT?

A

Lower testosterone level <50 ng/dL -> castration

30
Q

What is reversible method of androgen ablation?

A

LH-RH agonsist
* As effective as orchiectomy

31
Q

What are the LH-RH agonsits?

A
  1. Goserelin (Zoladex)
  2. Leuprolide (Leuprolide)
  3. Triptorelin (Trelstar LA)
32
Q

ADRs of LH-RH agonsits? How do you manage them?

A

Hot flashes, HA, Decreased libido, HA, osteoporosis, increased diabetes and CV, MI, weight gain
Tumor flares that can be controlled with antiandrogens
* Long term use -> Calcium and vit D supplementation

33
Q

Examples of GnRH antagonsit?

A

Degarelix (Firmagon)

34
Q

Benefits of using degarelix over LHRH agonsits?

A

Castrate levels achieved in 7 days instead of 28
* No tumor flares

35
Q

ADR of degarelix?

A
  1. Inj site rx
  2. Increased LFTs
  3. Osteoporosis requires calcium/vit D supplementation
36
Q

What are the antiandrogens agents?

A
  1. Flutamide
  2. Bicalutamide
  3. Nilutamide
  4. Enzalutamide
37
Q

ADRs of antiandrogens?

A

diarrhea, gynecomastia, hot flashes, LFT abnormalities

38
Q

Monitoring schedule for prostate cancer?

A

PSA: checked every 6-12 months for 5 years, annual after
DRE: Q12 monthsalso performed due to risk of recurrence with no rise in PSA levels seen

39
Q

Txs for prostate cancer?

A
40
Q

Tx for metastatic cancer?

A
  1. ADT
  2. Bilateral Orchiectomy
  3. LH-RH agonist/antagonist +/- Antiandrogen
  4. LH-HR agonist/antagonist + docetaxel
41
Q

What is bilateral orchiectomy?

A

Inexpensive procedural removal of testes

42
Q

Other than ADRs what are disadvantages of bilateral orchiectomy?

A
  1. May not be a surgical candidate
  2. Psychologically unaceptable
42
Q

ADRs of bilateral orchiectomy?

A

Immediate drop in testosterone within 12 hrs
ADR: impotence (less than with LHRH agonsits), hot flashes

43
Q

ADT therapies for metastatic prostate cancer?

A

LH-RH agonists:
Goserelin
Leuprolide
Triptorelin

GnRH antagonist:
Degaralix

44
Q

What is the difference between continuous and intermittenet ADT?

A

Due to side effects of ADT may consider intermittent ADT

Continuous tx for 1 year then stopped

Resumes when certain PSA level reached or symptoms appear again

45
Q

What is castrate naïve prostate cancer?

A

Cancer has progressed or metastasized but pt has not been treated with ADT therapy
* Advanced prostate cancer

46
Q

Systemic tx for castrate naive M0?

A
47
Q

Systemic tx for castrate naive M1?

A
48
Q

What is CRPC?

A

Cancer doesn’t respond to ADT:
* Progresses despite testosterone castrate level of < 50 ng/dL
* Add on secondary hormone therapy

49
Q

Drugs used for CRPC or metastatic?

A

Enzalutamide
Darolutamide
Apalutamide
Abiraterone

50
Q

MOA fo abiraterone?

A

Blocks the cortisol production from adrenal glands

51
Q

How should abiraterone be dosed?

A

Given with prednisone: formulations are not interchangeable
* Zytiga: must be given on empty stomach, at least 2 hrs before eating and no food for minimum of 1 hr after
* Yonsa: – micronized formulation – can be given without regard to food

52
Q

Tx for CRPC with PSADT more than 10 months?

A
53
Q

Tx for CRPC with PSADT less than 10 months?

A
54
Q

Tx for Small cell and neuroendocrine prostate cancer?

A
55
Q

First line tx for M1 CRPC?

A

Therapeutics IV (39 decks)

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