VP L4 Prostate cancer Flashcards
Risk factors for prostate cance (5)r
Age Race Genetic Androgens (rare in castration) Diet high in fat and red meat
2 protective factors
frequent ejaculation
diet high in lycopenes (tomatoes)
2 staging systems for PC
TNM Gleason
Clinical presentation
(similar to BPH) hesitancy post-micturition dribbling reduced void pressure frequency urgency nocturia
1/3 of patients present with symptoms of locally invasitve or mnetastatic disease. What is locally invasive and 4 symptoms
Perineal pain
Impotence
Incontinence
Harmatospermia
Metastatic symptoms (6)
bone pain hypercalcaemia spinal cord compression sciatica/paraplegia fracture lymphodema
2 emainations for diagnosis
Digital rectal examination (PR) - cannot detect T1
PSA (prostate specific androgen) glycopreotein that aids liquidification of semen, leaks though the cancer cell. Normal is
What can we use PSA for
diagnosis (although 20% of men will have raised PSA with no cancer)
or
monitoring pt before and after therapy
3 more hospitally exams you could do for diagnosis
TRUS (an ultrasound)
CT/MRI - find metastisises
RAdiolabelled bone scanning - specific way to find metastases
6 Treatment options
watchful waiting surgery - radical prostatectomy radiotherapy brachytherapy hormonal thearpy chemotherapy
Watchful waiting is suitable for who?
Well diferentiated, localised caner in elderly pt who have less than 10 years life expectancy or significant other comorbidities
Watchful waiting invilves
PR exams and PSA monitoring but no treatment unless progression
Surgery (radical proststectomy) is suitable for
T1 or T2 with at least 10 year life expectancy.
Problems with surgery
significant morbidity - 30-70% impotence, incontinance
Problems with surgery
significant morbidity - 30-70% impotence, incontinance
Radiotherapy is suitable for
pt who are not suitable for surgery but have a good life expectancy.
OR
symptom control in bony metastases
What are the side effects of radio therapy
similar to surgery but less frequent
What is brachytherapy
implacntation of needles containing radiotactive pelets into the prostate gland - left in perminantly
When is brachytherapy used
as a primary therapy in combo with radio therapy or andrgoen deprivation therapy - efficacy and side effect similar to surgery/radio
Hormonal therapies are used when?
loacaly advanced or metastatic cancer
what can we combine hormone therapy with
radio/surgery in locally advanced disease but limited evidence of benefit atm
How good are hormonal therapies
rapid response but only last 2 years - most patients die within 2y of developing hormone refractory prostate cancer
How do hormone therapies work?
block androgen drive that sustains most prostate cancers. Mainly testosterone from the testes.
How do hormone therapies work?
block androgen drive that sustains most prostate cancers. Mainly testosterone from the testes.
(Androgens are metabolised in the liver to DHT which is an active metabolite)
2 hormonal therapies and how do they work
Bilateral oridectomy - stops testicular secretion of testosterone
LHRH analogues - (-ve feedback on the pituitary) disrupt normal pulsitile release of LHRH. Initially increased LH, then decreases LH and testosterone
Why might there me a transient increase in tumour size with LHRH analogues? (Tumour flare)
How to avoid?
Initially increased LH, then decreases LH and testosterone.
Can worsen symptoms if not blocked therefore give a blocking drug e.g. bicalutaminde initially
What stimulates testosterone release?
LHRH from the hypothalamus
pituitary releases LH
2 e.g. of LHRH analogues
goserelin, tritorelin
how are LHRH analogues administed
3 monthly SC injections
how are LHRH analogues administed
3 monthly SC injections
Side-effects of hormonal therpaies
male menopause basically? impotence loss of libido gynaecomastia breast tenderness hot flushes depression and mood changes fatigue
Chemotherpy suitable for….
metastatic disease which is refractory to hormone therapy
this is a diffocult group of pt often older, poorer performance status
2 commonly used chemo regimens
Docetaxel + prednisolone
Mitoxantrone + prednisolone
How is docetaxel + pred administered?
Docetaxel 75mg/m2 IV infusion day 1
Prednisolone 5mg PO bd continuously
How long is docetaxel + pred given for?
21 days for up to 10 cycles
How does docitaxel work?
disrupts microtumular network or cells during cells division so mitosis cannot occur -> cell death
s/e of the docetaxel + pred regeimen
bone marrow supression
alopecia
nausea and vom - low ematogentic potential
myalgia/arthralgia
fluid retention
hypersensitivity (premed with deamthasone for the last two)
What to check before the docetaxel + pred regimen
- body durface area
- full blood count (platelets and neuts should be above level)
- LFTs (may need to reduce doc dose
What should be prescribe beofre docetaxel and pred regimen
antiemetics and dexamethasone (to reduce fluid retention)
name a new therapy for PC
how does it work?
abiraterone
inhibits androgen production from testes, adrenal gland and prostate tumour cells
Dosage form of abiraterone
oral
why give abiraterone (2)
improves survival and reduces pain
s/e of abiraterone
peripheral oedema hypokalaemia hypertension UTI elevated LFTs
disadvantage of abiraterone and enzalutamide
not funded by NHS
only though cancer durgs fund
what to monitor in abiraterone
LFTs every 2 weeks
name ANOTHER new therapy
how does it work
enzalutamide
androgen receptor signalling inhibitor
inhibits binding, nuclear translocation and association with DNA
When is enzalutamide licensed
metastatic prostate cancer that has progressed on or after docetaxel therapy
s/e of enzalutamide
head ache hot flushes memory problems visual hallucinations risk of seizures
