Prostate cancer Flashcards
What should you consider doing prior to performing a prostate biopsy?
Rectal swab for FQN organisms
What are the appropriate abx prior to prostate biopsy?
24 hrs of FQN or cephalosporin or Bactrim or Gentamicin
Mechanism and side effects of cipro?
Inhibits DNA gyrase
SEs: tendinitis tendon rupture worsening of myasthenia gravis, take care with Coumadin
When you insufflate and the patient becomes rapidly bradycardic, what is the differential dx?
Cardiac event
PE
Vagal response to insufflation
Air embolus
For patients with CRPC, what critical value is it Important to obtain?
PSA doubling time – this will help you to know whether they are at high risk for metastasis and will help you decide whether not to administer second generation anti-androgen therapy.
AND
ECOG status
According to a UA guidelines what are the treatment options for a patient with nonmetastatic castrate resistant prostate cancer?
Clinicians should offer either Enzalutamide or apalutamide in patients with a PSA doubling time less than 10 months.
You may also offer observation or Abiraterone
According to the AUA guidelines, what should you offer man with metastatic castrate resistant prostate cancer who are either asymptomatic or minimally symptomatic and have not had any chemotherapy?
In these patients who have a good performance status, you should offer enzalutamide, apalutamide, docetaxel, sip-T
In Patients who do not want or can I get one of these therapies, you can also offer bicalutamide, ketoconazole with prednisone, or simply observation
How do you determine, according to AUA guidelines, if somebody is symptomatic from their prostate cancer?
If somebody has metastases that are clearly symptomatic, and the patient is requiring regular opioid medication for pain relief from those metastases, then they would Be considered to have symptomatic metastases
According to the AUA guidelines what should you offer patients with metastatic castrate resistant disease that is symptomatic, and have not had prior docetaxel?
They should be either offered enza, Abi+prednisone, or docetaxel.
If the pain is from bone Mets and there are no visceral Mets, give Radium 223.
You should not offer Sip-T to patients with symptomatic disease.
According to the capital guidelines, what treatments can you offered to patients who are poor performance status (ECOG 3,4) With metastatic castrate resistant disease?
According to the guidelines you can essentially offer these patients anything other than Sip-T (but it says “may”)
According to a UA guidelines, what should you offer patients who have a good performance status and have metastatic castrate resistant disease, who have already received docetaxel therapy?
You should offer them Abi+prednisone, Enza, or Cabazitaxel
According to a UA guidelines, what should you offer metastatic castrate resistant patients who have already received docetaxel and who are poor performance status?
You should offer palliative care. You may consider other therapies but not more chemo and not Sip-T
What are the AUA recommendations for prophylactic anabiotics in patients with a previous total joint replacement?
Not all patients require prophylaxis. However substantial number will based on the following criteria:
Increase risk of hematogenous infection based on the following:
-join placed in the last two years
Dash immunocompromise state based on inflammatory joint disease, malnourishment, immunosuppression, or other comorbidities
Increased risk of bacteremia based on the type of procedure:
-Any stone manipulation, incision into the urinary tract, endoscopic procedure involving the upper urinary tract, any procedure where bacteria would be involved including entry into the bowel or in any patient who is colonized including those with stance and catheters, or with a history of UTIs or prostatitis
For a patient who needs salvage radiation therapy after prostatectomy who is still having urinary incontinence, what should you do?
Refer them to pelvic floor physical therapy, and do not radiate them until they have recovered urinary control. You have the option of giving hormone therapy during salvage radiation therapy, but this is not standard of care.
What are the purported risks of Adjuvant radiation therapy for patients with high risk features on radical prostatectomy?
Decreased risk of bio chemical recurrence
Decreased risk of local regional progression
Decreased risk of clinical progression
