prostate cancer

Question 1

risk factors for prostate cancer

Answer 1

age (>50)
race (black>white>asian)
family history (double risk)
genetics (BRCA1, BRCA2, Lynch syndrome)

Question 2

what is the prostate gland responsible for

Answer 2

fluid for semen, role in ejaculation, produces PSA

Question 3

PSA

Answer 3

prostate specific antigen (protein produced by prostate and measured by a blood test)
the primary screening modality for PRCA. normal range is undetectable

Question 4

hormonal regulation of androgen synthesis is mediated by ____

Answer 4

negative feedback loop, involving the hypothalamus, pituitary gland, adrenal glands, testes

Question 5

prostate cancer screening

Answer 5

males ages 55-69

Question 6

when is screening NOT recommended

Answer 6

males <40
males 40-54 at average risk
life expectancy <10 years

Question 7

signs and symptoms of prostate cancer

Answer 7

1. local disease typically asymptomatic
2. locally invasive disease: ureteral dysfunction including frequency, hesitancy, dribbling; impotence
3. advanced disease: weight loss, lower extremity edema, anemia. bone mets: back pain, pathological fractures

Question 8

what is gleason score

Answer 8

determined by a pathologist, ranges from 6-10 and correlates to grade groups 1-5
can help make treatment decisions

Question 9

treatment options for LOCALIZED disease

Answer 9

goal is cure
1. surgery: radical prostatectomy
2. androgen deprivation therapy, including orchiectomy
3. radiation
4. active surveillance

Question 10

options for androgen deprivation therapy

Answer 10

bilateral orchiectomy
LHRH agonist
LHRH agonist + 1st gen antiandrogen
LHRH antagonist

Question 11

treatment options for ADVANCED disease

Answer 11

1. ADT
2. Radiation
3. Active surveillance

Question 12

LHRH agonists

Answer 12

leuprolide, goserelin, triptorelin

Question 13

LHRH agonist initial/later effects

Answer 13

initially increases LH/ACTH production
Later on, continued LHRH stimulation shuts down LH/ACTH production

Question 14

dosing for LHRH agonists in general

Answer 14

parenteral: IM or SQ

Question 15

RX ADT toxicities

Answer 15

↑ osteoporosis, risk for fractures
↓muscle mass/strength, ↓size of penis & testicles
↑breast size/soreness, hot flash
↑CV risk, insulin resistance, lipid changes, obesity

Question 16

LHRH agonists are just as effective as _____

Answer 16

orchiectomy

Question 17

1st gen antiandrogens

Answer 17

nilutamide, flutamide, bicalutamide

Question 18

1st gen antiandrogens MOA

Answer 18

inhibits androgen receptor binding & uptake by prostate cancer cells

Question 19

uses for 1st gen antiandrogens

Answer 19

NOT MONOTHERAPY
should be used when starting LHRH agonists to prevent testosterone flare

Question 20

1st gen antiandrogens dosing generally

Answer 20

PO

Question 21

LHRH antagonists

Answer 21

degarelix and relugolix

Question 22

pearls for LHRH antagonists

Answer 22

no initial increase in LH/ACTH= no testosterone flare
quicker drop in testosterone
lower risk of cardiac events

Question 23

LHRH antagonists dosing, generally

Answer 23

degarelix is SQ
relugolix is PO

Question 24

what are the options for ADT in mPRCA

Answer 24

1. bilateral orchiectomy, LHRH agonist, LHRH agonist + 1st gen antiandrogen, LHRH antagonist
   PLUS/MINUS DOCETAXEL
2. bilateral orchiectomy, LHRH agonist, LHRH antagonist
   PLUS/MINUS abiraterone or 2nd generation

Question 25

2nd gen antiandrogens

Answer 25

apalutamide enzalutamide darolutamide

Question 26

2nd gen antiandrogens are _____ than 1st gens

Answer 26

stronger, broader

Question 27

2nd gen antiandrogens dosing, generally

Answer 27

PO

Question 28

2nd gen antiandrogens pearls

Answer 28

DRUG INTERACTIONS: REALLY BAD CYP3A4 AND OTHERS NEED TO CHECK DDIS

Question 29

mechanism of abiraterone

Answer 29

potent, selective, irreversible CYP17 inhibitor; interferes with androgen biosynthesis in adrenals & peripheral tissues

Question 30

abiraterone side effects

Answer 30

excess mineralocorticoid (HTN, hypokalemia, edema) fatigue, hot flash, liver toxicity

Question 31

abiraterone dosing considerations

Answer 31

PO on an empty stomach ALWAYS give with low dose prednisone 5 mg check CYP interactions

Question 32

what is CRPC

Answer 32

castration-resistant prostate cancer progression despite castrate levels of testosterone (<50 ng/dL)

Question 33

options for M0 CRPC

Answer 33

PSADT>10 months: monitoring preferred PSADT<10 months: 2nd gen antiandrogen

Question 34

options for M1 CRPC

Answer 34

continue ADT add RANKL inhibitor or bisphosphonate if metastatic to bone, can do palliative XRT for painful bone mets, best supportive care

Question 35

sipuleucel-T (Provenge) uses?

Answer 35

indicated for mCRPC adenocarcinoma but limited use: no previous Tx with docetaxel or novel hormone therapy, minimally symptomatic with no liver mets