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Prostate Cancer
Lecture 14
21
Pharmacology
Professional
04/19/2013

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Cards

Term
What are risk factor for prostate cancer?
Definition
- African American - 2x death rate
- Increased age - 50+
- Family history
Term
Where is the prostate?
Definition
- Base of bladder
- Anterior to rectum
- Encases urethra
- 2 lobes
- Acinar cells
- Release of testosterone, also comes from adrenal gland
Term
What is normal PSA?
Definition
- PSA should be less than 4
- ACS - discuss screening after 50, 45 if high risk
- USPSTF - recommends against PSA screening
Term
What supplements should NOT be used to prevent prostate cancer?
Definition
- Selenium
- Vitamin E
- From the SELECT trial
Term
How is prostate cancer diagnosed?
Definition
- Suspicion based on PSA or DRE
- Definitive - prostate biopsy
- Gleason score - how differentiated the tumor is. 1-6 = well, 7 - moderate, 8-10 = poor
Term
How does prostate cancer present?
Definition
- Local - increased frequency, urgency, impotence
- Metastatic - Weight loss, bone pain, fractures, cord compression
Term
What should be done with a prostate cancer patient with life expectancy <5 years, and asymptomatic?
Definition
Active surveillance until symptoms: PSA every 3 months, DRE every 6 months
Term
How is a prostate cancer patient in the very low risk category treated?
Definition
- <20 years - Active surveillance
- > 20 years - follow tx recommendations for low risk
Term
How is a prostate cancer patient in the low risk category treated?
Definition
- < 10 years - Active surveillance
- > 10 years - Active surveillance, radiation, RP +/- PLND
Term
How is a prostate cancer patient in the intermediate risk category treated?
Definition
- < 10 years - Active surveillance,
- > 10 years - Radiation + Androgen deprivation therapy for 4-6 months
Term
How is a prostate cancer patient in the high risk category treated?
Definition
- Radiation + ADT for 2-3 years
- RT + brachy + ADT
- RP + PLND
Term
How is a prostate cancer patient in the very high (locally advanced) risk category treated?
Definition
- RT + ADT x 2-3 years (Category 1)
- RT + brachytherapy ± ADT x 2-3 years
- RP + PLND (selected patients with no fixation)
- ADT (selected patients who are not candidates for definitive therapy)
Term
How is a prostate cancer patient in the metastatic risk category treated?
Definition
- Androgen deprivation
- Radiation + ADT x 2-3 years if M0
Term
What drugs are LHRH agonists?
Definition
Act at LHRH receptor in pituitary - reduction in LHRH/LH. Initial androgen surge
- Leuprolide/Lupron or Eligard or Viadur
- Goserelin/Zoladex
- Triptorelin/Trelstar
** Gynecomastia, hot flashes, impotence
Term
What drugs are LHRH antagonists?
Definition
Direct blockade of LHRH receptor on pituitary = no surge
- Degarelix/Firmagon
Term
What drugs are anti-androgens?
Definition
- Flutamide/Eulexin
- Bicalutamide/Casodex
- Nilutamide/Nilandron
**Liver failure, watch LFTs
Term
How is castration resistant prostate cancer treated?
Definition
- Non-metastatic - Antiandrogen. Relapse, follow metastatic guide
- Metastatic - Docetaxel or Abiraterone acetate (after Docetaxel failure)
Term
How is ADT administered for prostate cancer?
Definition
- Give LHRH agonist or antagonist
- Add anti-androgen
- Withdraw anti-androgen - avoids AR agonism
Term
How is docetaxel used to treat prostate cancer?
Definition
q3w regimen shows significant improvement in overall survival, PSA reduction
3A4 metabolism, PN
Term
What other therapies can be used for prostate cancer?
Definition
- Cabazitaxel - stabilizes microtubules. For resistance after docetaxel
- Mitoxantrone - Last line after all options for palliative care
- Abiraterone - 17alpha-hydroxylase inhibitor. Mineralocorticoid-related toxicity: give eplerenone. DIARRHEA. HEPATIC dosing
- Enzalutamide - inhibits nuclear translocation of AR
- Sipuleucel-T - reinfusion of T cells
Term
What is used for bone therapy from prostate cancer?
Definition
- Zoledronic Acid/Zometa - a bisphosphonate
- Denosumab - RANKL inhibitor, prevents osteoblasts
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