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Cancer CE & VP > VP L4 Prostate cancer > Flashcards

VP L4 Prostate cancer Flashcards

1
Q

Risk factors for prostate cance (5)r

A 
Age
Race
Genetic
Androgens (rare in castration)
Diet high in fat and red meat
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2
Q

2 protective factors

A

frequent ejaculation

diet high in lycopenes (tomatoes)

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3
Q

2 staging systems for PC

A

TNM Gleason

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4
Q

Clinical presentation

A 
(similar to BPH)
hesitancy
post-micturition dribbling
reduced void pressure
frequency
urgency
nocturia
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5
Q

1/3 of patients present with symptoms of locally invasitve or mnetastatic disease. What is locally invasive and 4 symptoms

A

Perineal pain
Impotence
Incontinence
Harmatospermia

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6
Q

Metastatic symptoms (6)

A 
bone pain
hypercalcaemia
spinal cord compression
sciatica/paraplegia
fracture
lymphodema
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7
Q

2 emainations for diagnosis

A

Digital rectal examination (PR) - cannot detect T1
PSA (prostate specific androgen) glycopreotein that aids liquidification of semen, leaks though the cancer cell. Normal is

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8
Q

What can we use PSA for

A

diagnosis (although 20% of men will have raised PSA with no cancer)

or
monitoring pt before and after therapy

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9
Q

3 more hospitally exams you could do for diagnosis

A

TRUS (an ultrasound)
CT/MRI - find metastisises
RAdiolabelled bone scanning - specific way to find metastases

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10
Q

6 Treatment options

A 
watchful waiting
surgery - radical prostatectomy
radiotherapy 
brachytherapy
hormonal thearpy
chemotherapy
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11
Q

Watchful waiting is suitable for who?

A

Well diferentiated, localised caner in elderly pt who have less than 10 years life expectancy or significant other comorbidities

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12
Q

Watchful waiting invilves

A

PR exams and PSA monitoring but no treatment unless progression

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13
Q

Surgery (radical proststectomy) is suitable for

A

T1 or T2 with at least 10 year life expectancy.

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14
Q

Problems with surgery

A

significant morbidity - 30-70% impotence, incontinance

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15
Q

Problems with surgery

A

significant morbidity - 30-70% impotence, incontinance

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16
Q

Radiotherapy is suitable for

A

pt who are not suitable for surgery but have a good life expectancy.
OR
symptom control in bony metastases

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17
Q

What are the side effects of radio therapy

A

similar to surgery but less frequent

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18
Q

What is brachytherapy

A

implacntation of needles containing radiotactive pelets into the prostate gland - left in perminantly

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19
Q

When is brachytherapy used

A

as a primary therapy in combo with radio therapy or andrgoen deprivation therapy - efficacy and side effect similar to surgery/radio

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20
Q

Hormonal therapies are used when?

A

loacaly advanced or metastatic cancer

21
Q

what can we combine hormone therapy with

A

radio/surgery in locally advanced disease but limited evidence of benefit atm

22
Q

How good are hormonal therapies

A

rapid response but only last 2 years - most patients die within 2y of developing hormone refractory prostate cancer

23
Q

How do hormone therapies work?

A

block androgen drive that sustains most prostate cancers. Mainly testosterone from the testes.

24
Q

How do hormone therapies work?

A

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)

25
Q

2 hormonal therapies and how do they work

A

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

26
Q

Why might there me a transient increase in tumour size with LHRH analogues? (Tumour flare)
How to avoid?

A

Initially increased LH, then decreases LH and testosterone.

Can worsen symptoms if not blocked therefore give a blocking drug e.g. bicalutaminde initially

27
Q

What stimulates testosterone release?

A

LHRH from the hypothalamus

pituitary releases LH

28
Q

2 e.g. of LHRH analogues

A

goserelin, tritorelin

29
Q

how are LHRH analogues administed

A

3 monthly SC injections

30
Q

how are LHRH analogues administed

A

3 monthly SC injections

31
Q

Side-effects of hormonal therpaies

A 
male menopause basically?
impotence
loss of libido
gynaecomastia
breast tenderness
hot flushes
depression and mood changes
fatigue
32
Q

Chemotherpy suitable for….

A

metastatic disease which is refractory to hormone therapy

this is a diffocult group of pt often older, poorer performance status

33
Q

2 commonly used chemo regimens

A

Docetaxel + prednisolone

Mitoxantrone + prednisolone

34
Q

How is docetaxel + pred administered?

A

Docetaxel 75mg/m2 IV infusion day 1

Prednisolone 5mg PO bd continuously

35
Q

How long is docetaxel + pred given for?

A

21 days for up to 10 cycles

36
Q

How does docitaxel work?

A

disrupts microtumular network or cells during cells division so mitosis cannot occur -> cell death

37
Q

s/e of the docetaxel + pred regeimen

A

bone marrow supression
alopecia
nausea and vom - low ematogentic potential
myalgia/arthralgia
fluid retention
hypersensitivity (premed with deamthasone for the last two)

38
Q

What to check before the docetaxel + pred regimen

A
  • body durface area
  • full blood count (platelets and neuts should be above level)
  • LFTs (may need to reduce doc dose
39
Q

What should be prescribe beofre docetaxel and pred regimen

A

antiemetics and dexamethasone (to reduce fluid retention)

40
Q

name a new therapy for PC

how does it work?

A

abiraterone

inhibits androgen production from testes, adrenal gland and prostate tumour cells

41
Q

Dosage form of abiraterone

A

oral

42
Q

why give abiraterone (2)

A

improves survival and reduces pain

43
Q

s/e of abiraterone

A 
peripheral oedema
hypokalaemia
hypertension
UTI
elevated LFTs
44
Q

disadvantage of abiraterone and enzalutamide

A

not funded by NHS

only though cancer durgs fund

45
Q

what to monitor in abiraterone

A

LFTs every 2 weeks

46
Q

name ANOTHER new therapy

how does it work

A

enzalutamide

androgen receptor signalling inhibitor

inhibits binding, nuclear translocation and association with DNA

47
Q

When is enzalutamide licensed

A

metastatic prostate cancer that has progressed on or after docetaxel therapy

48
Q

s/e of enzalutamide

A 
head ache
hot flushes
memory problems
visual hallucinations
risk of seizures

Cancer CE & VP (15 decks)

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