Prostate cancer: management

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Question 16

Prostate cancer: management of localised prostate cancer (T1/T2)

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depends on life expectancy and patient choice.

Options include:
conservative: active monitoring & watchful waiting

radical prostatectomy

radiotherapy: external beam and brachytherapy

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Localised advanced prostate cancer (T3/T4)

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hormonal therapy

radical prostatectomy:

radiotherapy: external beam and brachytherapy

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side effects of external beam and brachytherapy

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proctitis and are

also at increased risk of bladder, colon, and rectal cancer

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what are the hormonal therapy ?

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ANTI ANDROGEN THERAPY :

1) synthetic GnRH agonist or antagonists

2) bicalutamide

3) cyproterone acetate

4) abiraterone

bilateral orchidectomy

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what are the synthetic GnRH agonist

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GnRH agonists: e.g. Goserelin (Zoladex)

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Mechanism of GnRH agonists:

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lower LH levels longer term by causing overstimulation, resulting in disruption of endogenous hormonal feedback systems. The testosterone level will therefore rise initially for around 2-3 weeks before falling to castration leves

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Side effects of Goserelin (Zoladex)?

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rise in testosterone - ‘tumour flare’. The resultant stimulation of prostate cancer growth may result in bone pain, bladder obstruction and other symptoms

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How do we prevent the tumor flare ?

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therapy is often covered with an anti-androgen / GnRH antagonists

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Examples of GnRH antagonists

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degarelix

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Mechanism of action of bicalutamide

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blocks the androgen receptor

non-steroidal anti-androgen

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Mechanism of action cyproterone acetate?

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steroidal anti-androgen

prevents DHT binding from intracytoplasmic protein complexes
used less commonly since introduction of non-steroidal anti-androgens

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Mechanism of action of abiraterone

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androgen synthesis inhibitor

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Abiraterone is particularly useful for ?

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hormone-relapsed metastatic prostate cancer in patients who have no or mild symptoms after androgen deprivation therapy and before chemotherapy is indicated

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How does bilateral orchidectomy help

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rapidly reduce testosterone levels

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Complication of radical prostatectomy

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Erectile dysfunction

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what is indicated for treating metastatic castration resistant (hormone-relapsed) prostate cancer in adult ?

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Abiraterone acetate

blocking cytochrome P450 17 alpha-hydroxylase

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Metastatic prostate cancer disease chemotherapy ?

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docetaxel