VP L4 Prostate cancer

Question 1

Risk factors for prostate cance (5)r

Answer 1

Age
Race
Genetic
Androgens (rare in castration)
Diet high in fat and red meat

Question 2

2 protective factors

Answer 2

frequent ejaculation

diet high in lycopenes (tomatoes)

Question 3

2 staging systems for PC

Answer 3

TNM Gleason

Question 4

Clinical presentation

Answer 4

(similar to BPH)
hesitancy
post-micturition dribbling
reduced void pressure
frequency
urgency
nocturia

Question 5

1/3 of patients present with symptoms of locally invasitve or mnetastatic disease. What is locally invasive and 4 symptoms

Answer 5

Perineal pain
Impotence
Incontinence
Harmatospermia

Question 6

Metastatic symptoms (6)

Answer 6

bone pain
hypercalcaemia
spinal cord compression
sciatica/paraplegia
fracture
lymphodema

Question 7

2 emainations for diagnosis

Answer 7

Digital rectal examination (PR) - cannot detect T1
PSA (prostate specific androgen) glycopreotein that aids liquidification of semen, leaks though the cancer cell. Normal is

Question 8

What can we use PSA for

Answer 8

diagnosis (although 20% of men will have raised PSA with no cancer)

or
monitoring pt before and after therapy

Question 9

3 more hospitally exams you could do for diagnosis

Answer 9

TRUS (an ultrasound)
CT/MRI - find metastisises
RAdiolabelled bone scanning - specific way to find metastases

Question 10

6 Treatment options

Answer 10

watchful waiting
surgery - radical prostatectomy
radiotherapy 
brachytherapy
hormonal thearpy
chemotherapy

Question 11

Watchful waiting is suitable for who?

Answer 11

Well diferentiated, localised caner in elderly pt who have less than 10 years life expectancy or significant other comorbidities

Question 12

Watchful waiting invilves

Answer 12

PR exams and PSA monitoring but no treatment unless progression

Question 13

Surgery (radical proststectomy) is suitable for

Answer 13

T1 or T2 with at least 10 year life expectancy.

Question 14

Problems with surgery

Answer 14

significant morbidity - 30-70% impotence, incontinance

Question 15

Problems with surgery

Answer 15

significant morbidity - 30-70% impotence, incontinance

Question 16

Radiotherapy is suitable for

Answer 16

pt who are not suitable for surgery but have a good life expectancy.
OR
symptom control in bony metastases

Question 17

What are the side effects of radio therapy

Answer 17

similar to surgery but less frequent

Question 18

What is brachytherapy

Answer 18

implacntation of needles containing radiotactive pelets into the prostate gland - left in perminantly

Question 19

When is brachytherapy used

Answer 19

as a primary therapy in combo with radio therapy or andrgoen deprivation therapy - efficacy and side effect similar to surgery/radio

Question 20

Hormonal therapies are used when?

Answer 20

loacaly advanced or metastatic cancer

Question 21

what can we combine hormone therapy with

Answer 21

radio/surgery in locally advanced disease but limited evidence of benefit atm

Question 22

How good are hormonal therapies

Answer 22

rapid response but only last 2 years - most patients die within 2y of developing hormone refractory prostate cancer

Question 23

How do hormone therapies work?

Answer 23

block androgen drive that sustains most prostate cancers. Mainly testosterone from the testes.

Question 24

How do hormone therapies work?

Answer 24

block androgen drive that sustains most prostate cancers. Mainly testosterone from the testes.

(Androgens are metabolised in the liver to DHT which is an active metabolite)

Question 25

2 hormonal therapies and how do they work

Answer 25

Bilateral oridectomy - stops testicular secretion of testosterone LHRH analogues - (-ve feedback on the pituitary) disrupt normal pulsitile release of LHRH. Initially increased LH, then decreases LH and testosterone

Question 26

Why might there me a transient increase in tumour size with LHRH analogues? (Tumour flare) How to avoid?

Answer 26

Initially increased LH, then decreases LH and testosterone. | Can worsen symptoms if not blocked therefore give a blocking drug e.g. bicalutaminde initially

Question 27

What stimulates testosterone release?

Answer 27

LHRH from the hypothalamus | pituitary releases LH

Question 28

2 e.g. of LHRH analogues

Answer 28

goserelin, tritorelin

Question 29

how are LHRH analogues administed

Answer 29

3 monthly SC injections

Question 30

how are LHRH analogues administed

Answer 30

3 monthly SC injections

Question 31

Side-effects of hormonal therpaies

Answer 31

``` male menopause basically? impotence loss of libido gynaecomastia breast tenderness hot flushes depression and mood changes fatigue ```

Question 32

Chemotherpy suitable for....

Answer 32

metastatic disease which is refractory to hormone therapy | this is a diffocult group of pt often older, poorer performance status

Question 33

2 commonly used chemo regimens

Answer 33

Docetaxel + prednisolone | Mitoxantrone + prednisolone

Question 34

How is docetaxel + pred administered?

Answer 34

Docetaxel 75mg/m2 IV infusion day 1 | Prednisolone 5mg PO bd continuously

Question 35

How long is docetaxel + pred given for?

Answer 35

21 days for up to 10 cycles

Question 36

How does docitaxel work?

Answer 36

disrupts microtumular network or cells during cells division so mitosis cannot occur -> cell death

Question 37

s/e of the docetaxel + pred regeimen

Answer 37

bone marrow supression alopecia nausea and vom - low ematogentic potential myalgia/arthralgia fluid retention hypersensitivity (premed with deamthasone for the last two)

Question 38

What to check before the docetaxel + pred regimen

Answer 38

- body durface area - full blood count (platelets and neuts should be above level) - LFTs (may need to reduce doc dose

Question 39

What should be prescribe beofre docetaxel and pred regimen

Answer 39

antiemetics and dexamethasone (to reduce fluid retention)

Question 40

name a new therapy for PC how does it work?

Answer 40

abiraterone inhibits androgen production from testes, adrenal gland and prostate tumour cells

Question 41

Dosage form of abiraterone

Answer 41

oral

Question 42

why give abiraterone (2)

Answer 42

improves survival and reduces pain

Question 43

s/e of abiraterone

Answer 43

``` peripheral oedema hypokalaemia hypertension UTI elevated LFTs ```

Question 44

disadvantage of abiraterone and enzalutamide

Answer 44

not funded by NHS only though cancer durgs fund

Question 45

what to monitor in abiraterone

Answer 45

LFTs every 2 weeks

Question 46

name ANOTHER new therapy how does it work

Answer 46

enzalutamide androgen receptor signalling inhibitor inhibits binding, nuclear translocation and association with DNA

Question 47

When is enzalutamide licensed

Answer 47

metastatic prostate cancer that has progressed on or after docetaxel therapy

Question 48

s/e of enzalutamide

Answer 48

``` head ache hot flushes memory problems visual hallucinations risk of seizures ```