Onco 1: Prostate Flashcards
risk factors for prostate cancer
- Black
- immediate family hx
- age
- genetics:
- BRCA-2 mutation
- Lynch syndrome
prostate cancer screening
- consider harm of dx and overtreatment (chance of false positive)
- don’t screen pts over 70 (5 year suvival rate is already so good)
presentation of localized prostate cancer
NOT locally invasive
asymptomatic
presentation of locally invasice prostate cancer
not localized
urinary s/s
presentation of advanced prostate cancer
- back painn, cord compression
- lower extremity edema
- pathologic fractures
- anemia
- wt loss
prostate cancer prognosit factors
- prostate speific antigen (PSA)
- tumor size and exxtent
- hostologic grade (gleason score)
PSA level indications
- PSA > 10: 67% chance of prostate cancer
- normlaly <4, though pts cna develop prostate cnacer even withnormla PSA levles
gleason socre
scores cancer cells
- score 1: nearly normal cells
- 5: high grade tumor
scores are added together
- total 2-4 less aggressive
- 7-10 more aggressive
T, N, M staging for tumors
- T = tumor size
- N = node (lymph)
- NX: not assessed
- N0: negative
- N1:positive - M = metastass
- M0: no metastases
- M1: metastases
goal of prstate cnacer therapy for localized or locally invasive cancer
- conrol disease and symptoms
- decreased morbidity and mortality
curative
goal of prstate cnacer therapy for advanced or metastatic cancer
- palliative
- increased qol
- prolonged survival
treatment for localized/locally invasive postate cancer and low risk for recurrence
- observation
- very low risk and expected survival >20 (or low risk and >10): surveillance and can consider radiaiton
treatment for localized/locally invasive postate cancer and intermediate risk for recurrence
- 5-10 years expected survivail: observation or radiation
- > 10 yrs: surgery or radiation
- ADT is an option if pt also unfavorable
treatment for localized/locally invasive postate cancer and high and very high risk for recurrence
- < 5 years AND asymp: observation or ADT or radiation
- > 5 yrs OR symptomatic
- radiation + ADT (+/- abiraterone in very high risk)
- surgery + pelvic lymph node dissection (+/- radiation +/- ADT)
treatment for regional postate cancer
- < 5 years AND asymp: observation or ADT
- > 5 yrs OR symptomatic
- radiation + ADT (+/- abiraterone in very high risk)
- ADT +/- abiraterone
- surgery + pelvic lymph node dissection (+/- radiation +/- ADT) in select pts
treatment for advanced postate cancer and castrate naive/sensitive
- nonmetastatic: monitoring or ADT
- metastatic: ADT plus one of the following
- abiraterone
- enzalutamide
- apalutamide
- docetaxel 6 cycles
treatment for advanced postate cancer and castrate resistant and recurrent (and non-metastatic)
ADT +
- PSADT >10 months: monitoring or other seocndary therapy*
- PSADT < 10 months: apalutamide, enzalutamide, darolutamide, or secondary therapy
PSADT (PSA doubling time)
*othersecondary therapy: first gen antiandrogen, cs, antiandrogen withdrawal, ketoconazole +hydrocortisone
casstrate resistant definition
serum < 50 but disease progresssion
treatment for advanced adenocarcinoma postate cancer and castrate resistant and metastatic
- no prior docetaxel or hormone: aberaterone, docetaxel, enzalutamide
- no prior docetaxel, prior hormone: docetaxel (olaparib if BRCA mutation)
- prior docetaxel, no prior hormone: abieraterone, cabazitaxel, enzalutamide
- prior docetxel, prior hormone: cabazitaxel, docetaxel rechallenge
second line is the oppossite you did for first line (chemo vs hormone)
- Radium 223 INSTEAD of chemo if sympotatic bone metastaes
- Sipulecel-T in spcial cases
treatment for advanced small cell or neuroendocrine postate cancer and castrate resistant and metastatic
- chemo
- cisplatin/etoposide
- carboplatin/etoposide
- docetaxel/carboplatin
- cabazitaxel/carboplatin - supportive care
if unsure if small cell or adenocarcinoma, treat as adeno
secondary hormone therapies for the treatment of prostate cancer
- second gen antiandrogen: only for M0 and PSADT < 10 months (except enzalutamide whcih you can use in M1 too)
- androgenn metabolizm inhibitor (abiraterone): M1 only
- other (M0 or M1)
- first gen antiandrogen
- CS: hydrocortisone, prednisone, dexamethasone
- antiandrogen withdrawal
- ketoconazole + hydrocortisone
Second gen anti-androgen agents
- apalutamide
- darolutamide
- enzalutamide
first gen anti-androgen agents
- nilutamide
- flutamide
- bicalutamdie
ADT
andrgeon deprivation therapy
- surgical castration (has been replaced with medical)
- medical castration: LHRH agonist OR LHRH antag
