Prostate Cancer (3) – Flashcards
84 test answers
Unlock all answers in this set
Unlock answers 84question
most cases of prostate cancer are what type?
answer
adenocarcinoma
Unlock the answer
question
in early stages of prostate cancer, what promotes tumor cells to proliferate?
answer
androgens
Unlock the answer
question
how can prostate cancer spread?
answer
local extension lymphatic drainage hematogenous dissemination
Unlock the answer
question
prostate cancer common sites of metastases
answer
*skeletal* lung liver brain adrenal glands
Unlock the answer
question
what are the 2 ways we screen for prostate cancer?
answer
digital rectal exam (DRE) prostate specific antigen (PSA) testing
Unlock the answer
question
what are we looking for with a DRE?
answer
asymmetric areas induration nodules detect tumors in the posterior and lateral aspects of the prostate
Unlock the answer
question
what is PSA, and is it specific to prostate cancer?
answer
a glycoprotein produced by prostate epithelial cells NOT specific to prostate cancer
Unlock the answer
question
what can PSA be used for?
answer
detecting prostate cancer at early stages predicting outcome for localized disease monitoring disease-free status monitoring response to androgen-deprivation therapy or chemotherapy for advanced-stage disease
Unlock the answer
question
factors that interfere with PSA testing
answer
infection recent instrumentation ejaculation trauma BPH prostitis urinary retention 5alpha reductase inhibitors ketoconazole saw palmetto
Unlock the answer
question
when should patients begin prostate cancer screening according to NCCN?
answer
45 yo
Unlock the answer
question
how often should patients undergo screening according to NCCN?
answer
if PSA <=1 retest every 2-4 years otherwise every 1-2 years
Unlock the answer
question
when should screening be D/C according to NCCN?
answer
life expectancy <10 years- we don't need to screen someone who has a comorbidity that will out compete the cancer
Unlock the answer
question
prevention of prostate cancer
answer
dietary changes weight loss smoking cessation
Unlock the answer
question
which medications can be used to prevent prostate cancer?
answer
5alpha reductase inhibitors: finasteride dutasteride
Unlock the answer
question
what have finasteride and dutasteride been found to affect?
answer
decrease incidence of prostate cancer did not decrease prostate related deaths increase incidence of more aggressive prostate cancer
Unlock the answer
question
side effects of finasteride and dutasteride
answer
gynecomastia decreased libido erectile dysfunction
Unlock the answer
question
who should we consider for use of 5alpha reductase inhibitors?
answer
asymptomatic men with PSA <=3 must weight benefits vs. risk
Unlock the answer
question
was there evidence of effective chemoprevention with selenium and vitamin E?
answer
no
Unlock the answer
question
clinical presentation of early stage prostate cancer
answer
asymptomatic
Unlock the answer
question
clinical presentation of advanced stages
answer
*Micturition issues*- most specific for prostate cancer Impotence Lower extremity edema Anemia or pancytopenia Unexplained Weight loss Bone Pain
Unlock the answer
question
what is the Gleason score?
answer
prognostic value primary and secondary pattern observed are assigned a score (range of each 1-5). These scores are then added to yield a total score
Unlock the answer
question
how do we actually stage prostate cancer patients?
answer
consider the TNM, PSA, and Gleason score to stage into groups I-IV
Unlock the answer
question
what is important to consider when deciding treatment of prostate cancer?
answer
estimated life expectancy
Unlock the answer
question
what is "observation?"
answer
monitoring course of prostate cancer with the expectation to initiate therapy at the time of symptom development or change in DRE or PSA that suggests symptoms are imminent goal is to maintain QoL
Unlock the answer
question
who is observation most appropriate for?
answer
elderly men with comorbidities that will out-compete prostate cancer
Unlock the answer
question
what is active surveillance?
answer
watchful waiting, expectant management, or deferred treatment goal is to start treatment promptly with the intention for cure
Unlock the answer
question
who is active surveillance most appropriate for?
answer
younger men with indolent disease and older men with decreased life expectancy
Unlock the answer
question
when is radical prostatectomy indicated?
answer
when tumor is clinically confined to the prostate in recurrence
Unlock the answer
question
acute complications of prostatectomy
answer
hematuria, urinary retention, edema, impotence
Unlock the answer
question
chronic complications of prostatectomy
answer
proctitis, diarrhea, cystitis, impotence, incontinence
Unlock the answer
question
who is orchiectomy most appropriate for?
answer
men with spinal cord compression or ureteral obstruction
Unlock the answer
question
when can external beam radiation be used?
answer
clinically localized tumors effective for palliating bone mets
Unlock the answer
question
adverse effects of external beam radiation
answer
bladder and bowel adverse effects
Unlock the answer
question
what is brachytherapy?
answer
implantation of radioactive beads into the prostate
Unlock the answer
question
when is brachytherapy most appropriate as monotherapy vs. combo?
answer
monotherapy for lower risk disease combination therapy with EBRT and/or androgen deprivation therapy for higher risk disease
Unlock the answer
question
complications of brachytherapy
answer
urinary urgency and frequency erectile dysfunction rectal pain
Unlock the answer
question
what are the 2 types of androgen deprivation therapy?
answer
luteinizing hormone-gonadotropin-releasing hormone agonists (LHRH agonists) gonadotropin-releasing hormone antagonist (GnRH antagonist)
Unlock the answer
question
LHRH agonists MOA
answer
Stimulate the pituitary gland to produce more luteinizing hormone (LH) resulting in an initial elevation in testosterone production (Tumor Flare) Prolonged exposure eventually leads to pituitary receptor down regulation and a down stream reduction in testosterone production
Unlock the answer
question
what are the LHRH agonists?
answer
leuprolide depot groserelin implant triptorelin depot
Unlock the answer
question
what are the adverse effects of LHRH agonists?
answer
Increased the risk of cardiovascular disease, sudden cardiac death, stroke, and diabetes Osteopenia Tumor flare (first 2 weeks) Hot flashes Decreased libido, impotence Fatigue Gynecomastia QT prolongation
Unlock the answer
question
GnRH antagonist MOA
answer
Binds to GnRH receptors in the anterior pituitary gland block the receptor decrease the secretion of luteinizing hormone decrease in testosterone production *NOTE:* NO TUMOR FLARE
Unlock the answer
question
what is the GnRH antagonist?
answer
degarelix
Unlock the answer
question
adverse effects of degarelix
answer
Osteoporosis Elevations in LFT Fatigue Hot flashes QT prolongation Increased risk of CV disease and diabetes
Unlock the answer
question
what are antiandrogens used for?
answer
In combination with LHRH agonist, reduces risk of tumor flare
Unlock the answer
question
antiandrogen MOA
answer
Binds to androgen receptors and competitively inhibits binding of DHT and testosterone and prevents testosterone stimulation of cell growth in prostate cancer
Unlock the answer
question
what are the antiandrogens?
answer
flutamide bicalutamide nilutamide
Unlock the answer
question
adverse effects of antiandrogens
answer
Increased risk of CV disease Gynecomastia Hot flashes Diarrhea Methemoglobinemia (bicalutamide) Elevated LFTs Visual disturbances/ impaired dark adaptation (nilutamide)
Unlock the answer
question
very low risk patients: tumor, biopsy results, PSA
answer
tumor: T1c biopsy results: -Gleason Score <6 -Disease in fewer than 3 biopsy cores -< 50% prostate cancer detected in any core PSA: <10
Unlock the answer
question
low risk patients: tumor, biopsy results, PSA
answer
tumor: T1a-T2b biopsy results: Gleason score <=6 PSA: <10
Unlock the answer
question
intermediate risk patients: tumor, biopsy results, PSA
answer
tumor: T2b, T2c biopsy results: Gleason score 7 PSA: 10-20
Unlock the answer
question
high risk patients: tumor, biopsy results, PSA
answer
tumor: T3- intermediate risk with the presence of risk factors biopsy results: Gleason score 8-10 PSA: >20
Unlock the answer
question
very high risk patients: tumor, biopsy results, PSA
answer
tumor: T3b, T4 biopsy results: -Gleason score 8-10 -primary Gleason pattern 5 PSA: any
Unlock the answer
question
how do we treat very low risk patients? (20 yrs life expectancy)
answer
20 yrs: -active surveillance -EBRT or brachytherpay -radical prostatectomy
Unlock the answer
question
how do we treat low risk patients? (10 yrs life expectancy)
answer
10 yrs: -active surveillance -EBRT or brachytherapy -radical prostatectomy +/- PLND
Unlock the answer
question
how do we treat intermediate risk patients? (10 yrs life expectancy)
answer
10 yrs: -radical prostatectomy +/- PLND -ERBT +/- ADT (4-6 months) +/- brachytherapy -brachytherapy alone if favorable disease
Unlock the answer
question
how do we treat high risk patients? (all patients)
answer
ERBT in conjunction with 2-3 years of ADT ERBT and brachytherapy +/- ADT (2-3 years)
Unlock the answer
question
how do we treat very high risk patients? (all patients)
answer
EBRT and long-term ADT EBRT and Brachytherapy +/- long-term ADT Radical prostatectomy + PLND (patients with no fixation to adjacent organs) ADT alone
Unlock the answer
question
how do we treat nodal or metastatic disease (all patients)?
answer
ADT alone ERBT of the primary tumor + ADT (2-3 years)
Unlock the answer
question
what is often an effective change in therapy following a failed initial therapy?
answer
addition or removal of antiandrogen therapy
Unlock the answer
question
what is hormone refractory disease?
answer
all hormone manipulations have been exhausted (chemo, immunotherapy) goal is palliative
Unlock the answer
question
what is the gold standard for treatment of metastatic castrate resistant prostate cancer?
answer
chemotherapy
Unlock the answer
question
which chemotherapy agents can be used in mCRPC?
answer
docetaxel cabazetaxel
Unlock the answer
question
which chemotherapy agent has shown improved survival?
answer
docetaxel
Unlock the answer
question
when is cabazetaxel beneficial?
answer
in patients who have progressed on docetaxel
Unlock the answer
question
docetaxel MOA
answer
Promotes the assembly of mirotubules, and inhibits the depolymerization of tubulin leading to inhibition of DNA, RNA, and protein synthesis esp. good for visceral mets
Unlock the answer
question
cabazetaxel MOA
answer
microtubule inhibitor
Unlock the answer
question
what is our hormone therapy for mCRPC?
answer
abiraterone + prednisone enzalutamide
Unlock the answer
question
abiraterone MOA
answer
inhibits androgen synthesis by adrenal glands, testes, and prostate tumor
Unlock the answer
question
abiraterone DDI
answer
CYP2D6 CYP3A4
Unlock the answer
question
adverse effects of abiraterone
answer
Fluid retention hypertension hypokalemia joint swelling hot flashes diarrhea dyspnea adrenal insufficiency cardiac disease tachycardia afib elevated LFTs
Unlock the answer
question
who is abiraterone most appropriate for?
answer
patients previously treated with docetaxel
Unlock the answer
question
enzalutamide MOA
answer
androgen receptor signaling inhibitor inhibits nuclear translocation of androgen receptor, DNA binding, and co-activator recruitment greater affinity for the receptor
Unlock the answer
question
does enzalutamide exhibit tumor flare (aka the agonist activity)?
answer
no
Unlock the answer
question
what is our immunotherapy option?
answer
sipuleucel
Unlock the answer
question
what is sipuleucel?
answer
patient specific anticancer vaccine patients undergo 3 leukaphoresis sessions where we harvest cells that we send back to the company; their dose is prepared and they get INFUSIONS OF THOSE CELLS 2 weeks apart improved survival in mCRPC patients with minimally symptomatic disease
Unlock the answer
question
adverse effects of sipuleucel
answer
chills fever flu-like symptoms
Unlock the answer
question
why do we give patients "bone health" therapy?
answer
osteoporosis and osteopenia are common AE of ADT bone is the primary site of mets
Unlock the answer
question
what do all patients on ADT receive for prevention of ADT-induced bone loss?
answer
bisphosphonate therapy: -ZA -pamidronate
Unlock the answer
question
what can be used for treatment of ADT-induced bone loss?
answer
denosumab 60 mg SQ q6mos
Unlock the answer
question
what can be given for bone mets?
answer
radiotherapy bisphosphonate therapy (ZA, pamidronate) denosumab 120 mg SQ q4wks
Unlock the answer
