Term
| What are risk factor for prostate cancer? |
|
Definition
- African American - 2x death rate
- Increased age - 50+
- Family history |
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Term
|
Definition
- Base of bladder
- Anterior to rectum
- Encases urethra
- 2 lobes
- Acinar cells
- Release of testosterone, also comes from adrenal gland |
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Term
|
Definition
- PSA should be less than 4
- ACS - discuss screening after 50, 45 if high risk
- USPSTF - recommends against PSA screening |
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Term
| What supplements should NOT be used to prevent prostate cancer? |
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Definition
- Selenium
- Vitamin E
- From the SELECT trial |
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Term
| How is prostate cancer diagnosed? |
|
Definition
- Suspicion based on PSA or DRE
- Definitive - prostate biopsy
- Gleason score - how differentiated the tumor is. 1-6 = well, 7 - moderate, 8-10 = poor |
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Term
| How does prostate cancer present? |
|
Definition
- Local - increased frequency, urgency, impotence
- Metastatic - Weight loss, bone pain, fractures, cord compression |
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Term
| What should be done with a prostate cancer patient with life expectancy <5 years, and asymptomatic? |
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Definition
| Active surveillance until symptoms: PSA every 3 months, DRE every 6 months |
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Term
| How is a prostate cancer patient in the very low risk category treated? |
|
Definition
- <20 years - Active surveillance
- > 20 years - follow tx recommendations for low risk |
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Term
| How is a prostate cancer patient in the low risk category treated? |
|
Definition
- < 10 years - Active surveillance
- > 10 years - Active surveillance, radiation, RP +/- PLND |
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Term
| How is a prostate cancer patient in the intermediate risk category treated? |
|
Definition
- < 10 years - Active surveillance,
- > 10 years - Radiation + Androgen deprivation therapy for 4-6 months |
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Term
| How is a prostate cancer patient in the high risk category treated? |
|
Definition
- Radiation + ADT for 2-3 years
- RT + brachy + ADT
- RP + PLND |
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Term
| How is a prostate cancer patient in the very high (locally advanced) risk category treated? |
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Definition
- RT + ADT x 2-3 years (Category 1)
- RT + brachytherapy ± ADT x 2-3 years
- RP + PLND (selected patients with no fixation)
- ADT (selected patients who are not candidates for definitive therapy) |
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Term
| How is a prostate cancer patient in the metastatic risk category treated? |
|
Definition
- Androgen deprivation
- Radiation + ADT x 2-3 years if M0 |
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Term
| What drugs are LHRH agonists? |
|
Definition
Act at LHRH receptor in pituitary - reduction in LHRH/LH. Initial androgen surge
- Leuprolide/Lupron or Eligard or Viadur
- Goserelin/Zoladex
- Triptorelin/Trelstar
** Gynecomastia, hot flashes, impotence |
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Term
| What drugs are LHRH antagonists? |
|
Definition
Direct blockade of LHRH receptor on pituitary = no surge
- Degarelix/Firmagon |
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Term
| What drugs are anti-androgens? |
|
Definition
- Flutamide/Eulexin
- Bicalutamide/Casodex
- Nilutamide/Nilandron
**Liver failure, watch LFTs |
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Term
| How is castration resistant prostate cancer treated? |
|
Definition
- Non-metastatic - Antiandrogen. Relapse, follow metastatic guide
- Metastatic - Docetaxel or Abiraterone acetate (after Docetaxel failure) |
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Term
| How is ADT administered for prostate cancer? |
|
Definition
- Give LHRH agonist or antagonist
- Add anti-androgen
- Withdraw anti-androgen - avoids AR agonism |
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Term
| How is docetaxel used to treat prostate cancer? |
|
Definition
q3w regimen shows significant improvement in overall survival, PSA reduction
3A4 metabolism, PN |
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Term
| What other therapies can be used for prostate cancer? |
|
Definition
- Cabazitaxel - stabilizes microtubules. For resistance after docetaxel
- Mitoxantrone - Last line after all options for palliative care
- Abiraterone - 17alpha-hydroxylase inhibitor. Mineralocorticoid-related toxicity: give eplerenone. DIARRHEA. HEPATIC dosing
- Enzalutamide - inhibits nuclear translocation of AR
- Sipuleucel-T - reinfusion of T cells |
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Term
| What is used for bone therapy from prostate cancer? |
|
Definition
- Zoledronic Acid/Zometa - a bisphosphonate
- Denosumab - RANKL inhibitor, prevents osteoblasts |
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