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PHRM 864 therapeutics > Prostate Cancer Therapeutics > Flashcards

Prostate Cancer Therapeutics Flashcards

1
Q

what is the etiology of prostate cancer

A

testosterone is a growth signal to the prostate

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2
Q

what are risk factors for prostate cancer

A

-increased age
-african american
-family history

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3
Q

signs and symptoms of prostate cancer

A

-asymptomatic in early disease
-alterations in urinary habits
-impotence
-lower extremity edema
-weight loss
-anemia

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4
Q

what describes the natural progression of prostate cancer?

A

-indolent slow growing disease
-spreads by local extension via lymphs or hematogenously
-metasis to the bone, lung, liver

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5
Q

How to diagnose prostate cancer

A

-physical exam
-PSA level
-ultrasound
-biopsy of the prostate

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6
Q

what is used to grade prostate cancer

A

Gleason Score (2-10)

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7
Q

what is a gleason score of 2-4

A

slow-growing, well differentiated

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8
Q

what is a gleason score of 8-10

A

aggressive, poorly differentiated

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9
Q

what does a higher gleason score indicate

A

higher score, higher the risk of extracapsular spread

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10
Q

what is a normal PSA score

A

04

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11
Q

what PSA score requires evaluation

A

> 4

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12
Q

what PSA score is highly suspicious for Malignancy

A

> 10

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13
Q

what PSA velocity is suspicious for malignacy

A

> 0.75

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14
Q

how is treatment determined for prostate cancer

A

-stage
-grade of disease (gleason score)
-age of patient
-health status
-personal preference

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15
Q

when to use localized therapy in prostate cancer

A

Early stage

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16
Q

what is m1

A

metastatic, found on scans

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17
Q

what is m0

A

non metastatic (PSA only)

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18
Q

what is HSPC

A

hormone sensitive prostate cancer

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19
Q

what is CRPC

A

castrate resistant prostate cancer

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20
Q

what are 3 localized treatment options for prostate cancer

A

observation, active surveillance, radiation

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21
Q

what is localized observation therapy

A

-monitoring course of disease w/ expectation to deliver palliative therapy

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22
Q

what labs do you get and how frequently for localized observation therapy

A

-PSA and DRE every 6 months

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23
Q

what are the advantages and disadvantages for localized observational therapy

A

advantage: avoids immediate morbidity associated with treatment
disadvantage: risk of disease complications such as urinary retention or fractures

24
Q

what is localized active surveillance

A

watch and wait then treat if disease progresses

25
Q

what are the advantages and disadvantages to localized active surveillance

A

advantages: ~2/3 of patients eligible for surveillance will avoid therapy. QOL less affected
disadvantages: 1/3 of patients may require treatment. follow-up and tests may be necessary

26
Q

what are the pros and cons of localized radiation therapy

A

-equivalent with surgery and good alternative with those who are not surgical candidates
-complications include: bladder or rectal symptoms, ED
-can add adjuvant ADT if intermediate or poor risk

27
Q

when to use radical prostatectomy + PLND

A

-curative therapy
-men with > 10 years life expectancy due to perioperative morbidity

28
Q

what should radical prostatectomy be followed with

A

Adjuvant ADT therapy if lymph node positive/high risk recurrence

29
Q

what is the goal of ADT

A

goal is to include castrate levels of testosterone

30
Q

what drug classes can be used for ADT

A

-LHRH agonist +/- anti-androgen or orchiectomy
-Antiandrogens

31
Q

What are the options for LHRH agonists for ADT

A

-leuprolide
-Eligard
-Goserelin
-Triptorelin
-Histerelin

32
Q

what are toxicities of LHRH agonists

A

-Acute: tumor flare, ED
-Long term: osteoporosis, fracture, obesity, increased risk for CVE

33
Q

what are the anti-androgens

A

Flutamide
Bicalutamide
Nilutamide

34
Q

when to start anti-androgens and how long should they be on them?

A

-start 1 week prior to LHRH agonists
-continue for duration of therapy

35
Q

what is the first line for metastatic disease

A

palliation of disease
suppress the testosterone production

36
Q

treatment of m0HSPC

A

psa doubling time < 6 months: can give ADT
psa doubling time > 6 months can observe

37
Q

describe intermittent ADT in m0HSPC

A

start on LHRH agonist alone or with oral ADT
d/c androgren suppression when PSA drops below 4
can start and stop w/o being an issue

38
Q

what is the advantage of ADT in m0HSPC

A

decreased cost and side effects

39
Q

what is m0CRPC

A

psa still increasing and not responding to ADT but no distant metastasis

40
Q

treatment path for m0CRPC

A

continue ADT
add on either enzalutamide, apalutamide, darolutamide

41
Q

what is are contraindication for enzalutamide use

A

history of seizures
lots of CYP DDIs
dont have to take w/ prednisone

42
Q

what are toxicities for enzalutamide

A

fatigue
seizures
falls
weakness
foggy brain (big one)

43
Q

who should caution use with apalutamide

A

pts w/ history of seizures, QT prolongation, falls, and thyroid dysfunction

44
Q

compare the toxicities of darolutamide w/ other anti-androgen receptors

A

less toxicities and less severe toxicities
less fractures, falls, seizures, weight loss

45
Q

what is m1HSPC

A

patient now has visceral metastases
hormone sensitive disease

46
Q

what are the two categories of m1HSPC

A

low volume (fewer mets)
high volume (more mets)

47
Q

what is the treatment path for low volume m1HSPC

A

LHRH agonists or LHRH antagonists and add any of the following:
abiraterone + prednisone
enzalutamide
apalutamide

48
Q

what drug must be given with prednisone and why

A

abiraterone must be given with prednisone to help prevent adrenal insufficiency

49
Q

what is the treatment path for high volume m1HSPC

A

LHRH agonists or LHRH antagonists and add any of the following:
abiraterone + prednisone
enzalutamide
apalutamide
now chemo is an option

50
Q

what is the 1st line chemo regimen for m1HSPC

A

docetaxel + ADT

51
Q

what is the 1st line chemo regimen in M1CRPC

A

docetaxel + ADT + abiraterone/darolutamide

52
Q

what are PSA range categories

A

0-4 normal
>4 requires evaluation
>10 highly suspicious for malinancy

53
Q

what are the ACS guidelines for prostate screening in men

A

50 and up should have annual screening if PSA is >= 2.5 or every 2 years if PSA<2.5

54
Q

what group of men should start screening early and at what age

A

Black men w/ first degree relative of cancer screening at 45
40 yom w/ 1st degree relative of early prostate cancer

55
Q
A

PHRM 864 therapeutics (10 decks)

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