Prostate cancer drugs

Question 1

Finasteride

Answer 1

5 alpha reductase inhibitor
inhibit dihydrotestosterone to testosterone
Reduce incidence prostate cancer but no survival benefit

Question 2

High risk localised disease, what should you do first to lead to survival improvement before surgery?

Answer 2

8 months of androgen deprivation therapy

Question 3

Bicalutamide

Answer 3

Anti-androgen that binds AR and prevents binding of testosterone and dihydrotestsosterone

Question 4

Flutamide

Answer 4

Anti-androgen blocks binding of testosterone and dihydrotestosterone

Question 5

Leuprolide

Answer 5

synthetic GnRH analogue - bind to receptors on pituitary GN producing cells– initially increase LH and FSH causing tumour flare. After about a week, receptors are downregulated with decline in the pituitary production of LH NOT FSH

Question 6

Goserelin

Answer 6

synthetic GnRH analogue - bind to receptors on pituitary GN producing cells– initially increase LH and FSH causing tumour flare. After about a week, receptors are downregulated with decline in the pituitary production of LH NOT FSH

Question 7

Men with high volume disease ie more than 4 bony mets or any visceral, what to give?

Answer 7

Docetazel and ADT rather than ADT alone.

Question 8

Enzalutamide

Answer 8

Second generation antiandrogen drug which works in three ways

1. compeditive inhibit at AR
2. inhibit translocation of AR to nucleus
3. Prevent association of AR with DNA

CROSS BBB AND LOWER SEIZURE THRESHOLD

LOW RESPONSE RATE IF AR-V7 to enzalutamide and abiraterone

Question 9

Role for bisphosphonates in prostate cancer?

Answer 9

Metastatic disease increases time to first skeletal related event if CASTRATION RESISTANT only

Question 10

Radium-223

Answer 10

Prostate ca with BONY mets only and castration resistant- localised deposition of radioactive particle. Improve life expectancy and increase time to skeletal related event

Question 11

Sipuleucel-T

Answer 11

Dendritic cell vaccine- pt cells taken out, exposed to prostatic acid phosphatase then reinfused to attack tumour cells.

Question 12

Abiraterone

Answer 12

Oral therapy in castration resistant disease
Irreversible inhibits 17 alpha hydroxylase and 1,20 lyase to stop androgen synthesis in adrenals and tumour that keep going compared with castration.
As a side effect there is a build up of cholesterol and steroid precursors with apparent mineralocorticoid effect so get hypokalaemia and fluid retention. Dampen this effect by giving some pred.
note actual aldosterone level decreases

Question 13

Galeterone

Answer 13

androgen receptor degrader
also
inhibits testosterone synthesis byt inhibiting CYP17A1