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PROSTATE CANCER
| Question | Answer | |
|---|---|---|
| Prostate cancer Risk Factors | Age, Gender, Ethnicity, Family History, AGENT ORANGE EXPOSURE, increases risk of death in AA males | |
| Prostate anatomy | Helps control urine flow Produces fluid component of semen Produces PSA and acid phosphate | |
| Prostate Cancer Screening | DRE (digital rectal exam) PSA Transrectal US (NOT DX) Biopsy (DIAGNOSTIC) | |
| THINGS THAT INCREASE PSA | BPH (prostate growing) Age Prostatits Ejaculation DRE | |
| THINGS THAT DECREASE PSA | Drugs: Finasteride, Dutasteride, Herbs?? Obesity | |
| Prostate Cancer S/Sx | decreased urinary stream Bladder/bowel incontinence urinary frequency (need to go often and cant) Hematuria (blood in urine) Bone pain Lower extremity numbness or weakness | |
| PCPT TRIAL | Finasteride 5mg vs placebo Finasteride decreases PC but showed no difference in overall survival Finasteride increased high grade PC compared to placebo making the cancer more aggressive (AD) | |
| REDUCE TRIAL | Dutasteride VS Placebo Dustasteride showed a 23% reduction compared to placebo | |
| COMBAT Trial | Dutasteride + Tamsulosin VS Tamsulosin 40% lower incidence of prostate cancer with dutasteride + tamsulosin alone | |
| ASCO Recommendation for prostate cancer | 5-AR inhibitors decrease but DO NOT eliminate risk for prostate cancer. MAIN IDEA: no difference in survival. | ADEs for 5-AR inhibitors: gynecomastia, ED, decreased libido, nausea, abdominal pain, asthenia, dizziness, flatulence, headache, rash, muscle weakness, teratogenicity |
| SELECT Trial | Selenium & Vitamin E Men only taking Vit E had a 17% increase risk in developing prostate cancer | DO NOT GIVE VITAMIN E ALONE TO AT RISK PATIENTS |
| Diagnosing Prostate Cancer | DRE, PSA, Transrectal US, US guided biopsy | NORMAL PSA = 0-3 ng/mL 3ng/mL - needs further eval >10 ng/mL - highly sus!! |
| GLEASON SCORE | grading system for evaluating architectural details of cancer cells 2-4 = BEST prognosis = 12% risk of spread 5-6 = Intermediate = 33% risk 7-10 = Worst = 61% risk | the higher the score the higher the risk of spread and the worse the cancer is |
| TXT FOR CURABLE PROSTATE CANCER | Surgery or Radiation then maybe ... ADT add Abiraterone if very high risk | ADT: GnRH agonist +/- antiandrogen GnRH antagonists |
| (Curable PC) Androgen Deprivation Therapy (ADT) | GOAL: serum test <50ng/dL in 1 month | TXT options: surgical castration - orchiectomy or Medical castration (1st line) GnRH agonist +/- antiandrogen (BIC) GnRH antagonists (degarelix or relugolix) MAJOR ADVANTAGE of GnRH - immediate down regulation of testosterone |
| (Curable PC) GnRH Agonists | Goserelin Histerelin Leuprolide Triptorelin | ACUTE AE: tumor flare, gynecomastia, hot flashes, erectile dysfunction, edema hyperglycemia, QTc prolongation LONG TERM AE: osteoporosis, obesity, insulin resistance, alteration in lipids, cardiovascular disease (Increased MI) |
| (Curable PC) 1st generation Anti-androgens | Flutamide Bicalutamide Nilutamide | Nilutamide ADEs - disulfiram rxn |
| (Curable PC) GnRH Antagonists | Degarelix Relugolix | ADRs: Hot flashes, weight gain, injection sit discomfort (only degarelix) QTc prolongation, increase in liver enzymes |
| TXT Nonmetastatic Castration Resistant PC | Apalutamide Darolutamide Enzalutamide (ADE) | you pick ONE and add it to ADT for TXT |
| Apalutamide | 2nd gen anti-androgen | TOXICITIES: Rash, hypothyroidism DDIs: inducer for CYP3A4 |
| Darolutamide | 2nd gen anti-androgen | Take BID w food |
| Enzalutamide | 2nd gen anti-androgen | TOXICITES: SEIZURES |
| Metastatic Castration Sensitive PC | Docetaxel + Darolutamide Docetaxel + Abiraterone Apalutamide Enzalutamide | PICK ONE combo or solo drug to add to ADT |
| Metastatic Castration Resistant PC (CRPC) | Abiraterone Docetaxel Enzalutamide Radium (bone mets only) PARP inhibitors | |
| mCRPC Standard of Care | Docetaxel + Prednisone | TOXICITIES: Myelosuppression |
| mCRPC NO BRCA MUTATION 1ST LINE | PICK 1: Docetaxel Abiraterone Radium 223 (mets to bone only) Enzalutamide | if the pt has received a therapy previously, choose a different agent |
| mCRPC BRCA MUTATION OR HRRm | Pick 1: Niraparib + Abiraterone Olaparib + Abiraterone Talazoparib + Enzalutamide | if the pt has received a therapy previously, choose a different agent |
| mCRPC MSI-HIGH (MSI-H) | PEMBROLIZUMAB | if the pt has received a therapy previously, choose a different agent |
| PARP inhibitors | Niraparib Olaparib Talazoparib used for BRCA mutated prostate cancer combined with abiraterone | COMMON N/O ADRs: Myelosuppression, Nausea, Fatigue, Increase MDS, AML Niraparib: Headache Inc LFTs, glucose HTN Olaparib only: Blood clots, pneumonitis Talazoparib ADRs: Anemia, thrombocytopenia, neutropenia |
| Bone metastisis TXT | PICK 1: Zolendronic acid (inhibits osteoclasts) Denosumab (RANK-L inhibitor) PT MUST TAKE VITAMIN D OR CALCIUM IF ON EITHER OF THESE MEDS | Radium 223 can be used to txt cancer in the bone and can be combined with either zolendronic acid or denosumab |
Created by:
texantaco