Sweatman Prostate Cancer

Question 1

first line tx for prostate cancer

Answer 1

combined androgen blockade-medical or surgical castration plus pure anti-androgen

Question 2

converson of DHEA to DHT

Answer 2

3 beta- dehydroepiandrostenedione

Question 3

theory behin GnRH treatment

Answer 3

GnRH normally release is pulsatile, tx with GnRH agonist is constant–> result sin downregulation of GnRHReceptors on pituitary–>decreased FSh and LH in 2-4 weeks

Question 4

Initial outcome of GnRH agonists

Answer 4

transient increase in FSH and LH can cause disease flare

*give AR blocker coinsidingly

Question 5

Name the GnRH agonist

Answer 5

Gosorelin
Histrelin
Leuprolide
Triptorelin

Question 6

side effects of the GnRH agonists

Answer 6

reduced lipido, elevated trigs, weight gain, DM, DECREASED BONE MINERAL DENSITY, SEIZURES (HISTRELIN, SUICIDE (HISTRELIN), CV EFFECTS EDEMA HTN MI AND HF (LEURPROLIDE)

Question 7

SEIZURES AND SUICIDAL IDEATION

Answer 7

HISTRELIN

Question 8

MI AND HEART FAILURE

Answer 8

LEUPROLIDE

Question 9

reversible GnRH antagonist

Answer 9

Degarelix (SC)

• reduces FSH and LH secretion
• castrate T levels in 3 days

Question 10

will bring T levels down quicker and avid disease flar en route to castration

Answer 10

Degerelin

Question 11

Severe AE’s with degerelin

Answer 11

Prolong QT

less severe others** elevated LFTS, sweats HTN, arthralgia, impotence

Question 12

Drug for Prostate CA with comparable effects to estradiol

Answer 12

Estramustine

Question 13

MOA for Estramustine

Answer 13

inhibits microtubules, promoting dis-assembly and G2/M arrest
*causes DNA strand breakage

Question 14

AE’s of Estramustine

Answer 14

gynecomastia. mastalgia, impotence, GI upset

Question 15

When estramustime works too well what can happen (AE’s of another molecule)

Answer 15

Same side effects of Estradiol

-thromboembolic Dz (PE and DVT), MI, CVA, Edema

Question 16

name the Androgen Receptor blockers

Answer 16

Bicalutamide
Enzalutamide
Flutamide
Nilutamide

Question 17

all Androgen receptor blockers end in

Answer 17

-lutamide

Question 18

do AR blockers affect circulating androgen levels

Answer 18

no-but the adverse effects are from apparent decreases androgen levels

Question 19

only AR blocker indicated for women’s health issue–> Hirsutism and PCOS

Answer 19

flutamide

Question 20

male teratogenicity

Answer 20

enzalutamide

Question 21

prostate > central

-antagonist + agonist activity

Answer 21

biclutamide

Question 22

prostate and central

-antagonist

Answer 22

Enzalutamide (T)

Nilutamide

Question 23

Prostate only

-antagonist

Answer 23

flutamide

Question 24

BBW for flutamide

Answer 24

interstitial pneumonitis

Question 25

respiratory insufficiency and increased time to accomodate to light from dark with

Answer 25

nilutamide

Question 26

URTI with

Answer 26

enzalutamide

Question 27

3/4 AR are teratogenic except

Answer 27

nilutamide

Question 28

drug that stimulates T cells against Prostatic Acid Phosphatase

Answer 28

Sipuleucel-T

Question 29

the cell that carrie out the action for Sipucel is

Answer 29

CD8 t cells-->intracelluar/cancer cell lysis

Question 30

Name the 17 alpha hydroxylase inhibitor (CYP17)

Answer 30

Abiraterone

Question 31

difference between ketoconazole and abaterone

Answer 31

Abaterone increases mineralocorticoids, ketoconazole decreases mineralocorticoids and cortisol production

Question 32

CYP17 | CYP17 inhibitor

Answer 32

17 alpha hydroxylase | abaterone

Question 33

SE of Aabaterone

Answer 33

hyper-mineralocoricoid state HTN, HYPOKALEMIA, HYPERNATREMIA *CAUTING WITH PREVIOUS CV ISSUE

Question 34

pregnancy category for abaterone

Answer 34

category X-->woman precautions too

Question 35

Give abaterone with

Answer 35

glucocorticoids to inhibit ACTH overdirve

Question 36

abrupt stoppage of abaterone

Answer 36

adrenal crisis

Question 37

high total PSA seen with

Answer 37

Prostatic Cancer Free: total ratio is decreased in cancer than with BPH

Question 38

high free PSA seen in

Answer 38

BPH free: total ratio is increased more in BPH than in prostatic CA

Question 39

5 alpha reductase inhibitors are recommended

Answer 39

NO

Question 40

5 alpha reductase inihibitors | thought to be chemopreventative

Answer 40

finasteride | dutasteride

Question 41

which ER is protective

Answer 41

ERB-> tumor supressive effect | ERa--> proliferative, pro-malignant, inflammatory

Question 42

convential agents in prostate cancer (advanced)

Answer 42

Docetaxel and Carbazitaxel-taxane (usedful in MDr tumorsa because a poor substrate for pgP pump) .Mitoxantrone