Urological cancer

Question 1

Role of testosterone in prostate cancer

Answer 1

Testosterone -> dihydrotestosterone

Dihydrotestosterone binds to androgen receptor in cancer cells, driving its growth and PSA production

Question 2

Definition of castrate resistant disease

Answer 2

Prostate Ca that progresses despite castrate level of testosterone <1.7nmol/L in Australia, 50ng/dL in US

Question 3

Symptoms of castrate resistant disease

Answer 3

• clinical progression: worsening symptoms
• radiographic progression (on bone scan/CT scan)
• biochemical progression (raising PSA)

Question 4

Treatment of castrate sensitive disease

Answer 4

Androgen deprevation via
- GnRH agonist (goserelin, leurpolide)

• GnRH antagonist (degarelix)

Question 5

Main side effect of GnRH agonist

Answer 5

↑production of testosterone can may be associated with progression of prostate Ca.

May cause a “transient flare” e.g. ureteric retention, bone pain.

Question 6

How do you manage side effect of GnRH agonist

Answer 6

by concomittant use of anti-androgen (e.g. cyproterone) prior to starting GnRH agonist or orchidectomy

Question 7

Benefit of GnRH antagonist

Answer 7

Rapid reduction in serum testosterone and avoids clinical flare phenomenon.. Lower rate of CVS complications

Question 8

Major change in last 5 years for men with castrate sensitive metastatic prostate Ca is to add the following to ADT:

*examinable material

Answer 8

○ Docetaxel chemotherapy (6 cycles)
○ Abiraterone acetate
○ Enzalutamide
○ Apalutamide
- Local radiotherapy to prostate

Question 9

Treatment for metastatic castrate resistant prostate Ca

Answer 9

• chemotherapy: docetaxel and cabazitaxel