Prostate Cancer Flashcards
(19 cards)
What is active surveillance?
Monitoring prostate cancer with tests (eg. biopsy, DRE, PSA) instead of curing prostate cancer.
When is active surveillance recommended?
Men with low risk prostate cancer that is confined to the gland with a long life expectancy (>10 years)
What is watchful waiting?
Monitoring prostate cancer for any symptoms that arise instead of curing prostate cancer.
When is watchful waiting recommended?
Men with low risk prostate cancer that is confined to the gland with a lower life expectancy, especially those with co-morbidities.
Why is watchful waiting preferred in men with comorbidities?
These men will probably die from comorbidities rather than prostate cancer. Watchful waiting helps control symptoms and also prevent men from being subject to the adverse effects of prostate cancer treatment.
What is androgen deprivation therapy?
Also known as castration, decreases testosterone production in the body which contributes to prostate cancer growth.
What are the two forms of androgen deprivation therapy?
Bilateral orchiectomy (surgical removal of testicles) Pharmacological hormone therapy
Why is pharmacological hormone therapy preferred?
Bilateral orchiectomy associated with worse psychological outcomes
Bilateral orchiectomy permanent, pharmacological is reversible
GnRH agonist examples and MOA?
Goserelin, leuproelin
Agonist for the GnRH receptor which blocks the production of LH and FSH which results in inhibition of testosterone production.
What is the ‘flare phenomenon’?
GnRH agonists cause initial transient increase in LH and FSH which results in the increased production of testosterone which lasts for ~3 days. This can cause the prostate cancer to increase in size.
How is the ‘flare phenomenon’ managed?
Antiandrogen therapy (e.g. bicalutamide)
Antiandrogen examples and MOA?
Bicalutamide, flutamide
Binds to androgen receptors on prostate cancer to inhibit androgen-dependent growth.
What is the role of second-generation antiandrogens? Examples?
Enzalutamide, abiraterone
Used in prostate cancer that has not responded to initial ADT treatment.
Enzalutamide MOA?
Binds to androgen receptors on prostate cancer to inhibit androgen growth, also inhibits nuclear translocation of the androgen receptor.
Abiraterone MOA?
Inhibits products of the CYP17 gene in the testes and adrenal glands which inhibits testosterone production.
Why is abiraterone usually administered with a corticosteroid (e.g. prednisone)?
Inhibition of CYP17 gene products in adrenal glands causes adrenal gland suppression which decreases cortisol production.
What chemotherapy agents are used for prostate cancer?
Taxanes: docetaxel, cabazitaxel
Cabazitaxel not available in NZ thus docetaxel must be used, but has better adverse effect and toxicity profile.
Do we prefer abiraterone or enzalutamide for metastatic prostate cancer?
Abiraterone. Enzalutamide is not available in NZ.
However, abiraterone is also very expensive and requires special authority.
What is the role of zoledronic acid in prostate cancer?
Prostate cancer most commonly metastasises to the bones, causing bone pain and weakness. Bisphosphonates such as zoledronic acid help prevent this.
