Flashcards in Prostate Deck (28):
Most important risk factors associated with prostate cancer?
Age, race and positive family history
What mutation is associated with positive family history and young age for prostate cancer?
What are the subtypes of prostate cancer?
Prostate cancer stage is based on what 3 factors?
What are the two main categories of prostate cancer?
Localized and Metastatic
What are t stages for prostate cancer?
T1: no appreciated on exam or imaging
T2: confined to prostate
-T2a: 50% 1 lobe,
-T2c: both lobes
T3: outside prostate (T3b: seminal vesicle involvement)
T4: into adjacent tissues
Most important T stage, Gleason Score and PSA? Why?
T2B, 7, 10-20; helps determine Intermediate risk
Low is Int
What are treatment options for localized prostate cancer?
Surgery, RT or watchful waiting
Which risk group is appropriate for watchful waiting?
Low risk (Gleason
When after prostatectomy do you immediately give ADT? Data?
Node positive disease; Messing et al, significant improvement in PFS and OS at 11.9 years
Who gets ADT with RT for localized disease? And for how long?
Intermediate risk: 3-4 months
High risk: 2-3 years
Clinical node positive or T3: indefinite (would recommend surgery here)
What are side effects of ADT?
loss of libido
loss of bone density (can start as early as 6 months)
reduced lean mass
increased LDL, reduced HDL, increased Triglycerides
reduced insulin sensitivity
What should be done to minimize bone loss?
Dexa scan at start and regular intervals
calcium (>1200 mg/d)
vitamin D (>800 IU/d)
aerobic/ resistance exercises
When are bisphosphonates prescribed for prostate cancer? Why?
Only in castrate resistant setting
- prevents skeletal related events (RT to bone, fracture, cord compression or surgery to bone)
** otherwise only given for therapy in patients with severe osteopenia or porosis (T score > 2.0)
Is cardiovascular-related mortality increased due to prolonged ADT therapy?
When after prostatectomy do you do radiation? What are common adverse effects?
positive surgical margins
involvement of seminal vesicles or pT3
- rectal, uretheral strictures and incontinence
What is PSA level post-prostatectomy for biochemical recurrence?
> 0.2 x 2 with no evidence of metastatic disease
Why is biochemical recurrence difficult to assess post-RT?
there may be residual prostatic tissue; nadir may take up to a year; usually considered significant for biochemical recurrence if 2ng/mL above nadir
What is PSA cut-off by ASTRO for salvage RT in localized prostate cancer?
For metastatic prostate cancer at presentation, if low volume, what is initial tx option and when is PSA measurement predictive of prognosis?
androgen blockade ( mono or dual )
7 months predicts medial survival
-PSA>4 = 13 months
-PSA 0.2-4 = 44 months
What should you always check before determining someone has castrate-resistant prostate cancer? (2 things)
When can intermittent hormone blockade be used?
only localized disease with biochemical recurrence
When must continuous hormone blockade be used?
metastatic disease (SWOG 9346, Hussain, NEJM 2013)
When should chemotherapy be used for metastatic cancer as first line therapy?
high volume of disease
- visceral metastasis
- 4 or more bone lesions (1 beyond pelvis & axial skeleton)
- median OS 57.6 months versus 44 months, HR 0.61, P=0.003, CHAARTED, E3805 trial)
What must consider for rapid disease progression, especially if visceral metastasis with low PSA rise?
small cell conversion
What are advanced androgen blockade agents? Their mechanism of action? In what setting can the be used?
Abiraterone = irreverisble inhibitor of CYP-17A (HTN, LE edema & LFT rise)
Enzalutammide = binds androgen receptor and prevents nuclear translocation (fatigue, diarrhea, hot flashes, seizures)
- both in pre-docetaxel and post-docetaxel
What immunotherapy is approved for metastatic castrate resistant prostate cancer?
Sipuleucal T for asymptomatic or minimally
- median OS 25.8 versus 21.7 months (IMPACT trial)