Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
82 Cards in this Set
- Front
- Back
|
What is the most commonly diagnosed cancer in the US?
|
Prostate cancer
|
|
|
What is the second leading cause of death in men?
|
Prostate cancer
(higher incidence and death rate in African Americans vs Caucasians) |
|
|
What are the risk factors of prostate cancer?
|
1. Age
(median age of dx is 66, rare before 44) 2. Race (African American more common, Asian less common) 3. Family history (16% lifetime risk if 1 first-degree relative) (8% lifetime risk if no family hx) 4. Diet (Vitamin E, selenium, soy and lycopenes may protect) (High fat may increase risk) (Long term vasectomy (> 20 yrs) may increase risk) |
|
|
What were the results of the prostate cancer prevention trial (PCPT) comparing finasteride to placebo?
|
-Finasteride reduced rate of acute urinary retention, reduced risk of progression of BPH, had a reduction in prostate cancer prevalence
*Finasteride is NOT approved for preventing or reducing risk of prostate cancer* |
|
|
What have been identified as 4 promising nutrients in the role of chemoprevention of prostate cancer?
|
1. Phytoestrogens/isoflavones
2. Vitamins D & E 3. Selenium 4. Lycopene |
|
|
What results of a digital rectal exam indicate a need for further evaluation?
|
-Prostate having the consistency of chin (as opposed to the tip of the nose)
-Lumps, hardness, inability to move the prostate |
|
|
What is PSA?
|
-Glycoprotein produced by epithelial cells of the prostate
-Kallikrein-like serine protease which liquifies seminal secretions -Specifc to the prostate, NOT specific to cancer |
|
|
What is the normal range of PSA?
|
0-4 ng/mL
|
|
|
PSA > ____ requires further evaluation by biopsy
|
2.5-4
|
|
|
PSA > ____ is highly suspicious for malignancy
|
10.0
|
|
|
What happens to the prostate with age?
|
Size increases
|
|
|
What velocity of PSA is more suspicious for malignancy?
|
> 0.75 ng/mL/year
|
|
|
What level of Free PSA is associated with prostate (cancer?)?
|
< 25% Free PSA
|
|
|
What test is indicated as follow-up test after an abnormal PSA or DRE?
|
Transrectal Ultrasonography (TRUS)
|
|
|
At what age does the NCCN recommend that all men be offered PSA with DRE?
|
>40 years old
|
|
|
True or False: PSA screening is controversial.
|
TRUE
|
|
|
True or False: Early prostate cancer is asymptomatic.
|
TRUE
|
|
|
What signs and symptoms are associated with advanced disease?
|
1. Alteration of micturation
2. Impotence 3. Lower extremity edema 4. Anemia 5. Weight loss |
|
|
What type of growth is common in early stages of prostate cancer?
|
Indolent
|
|
|
How does prostate cancer typically spread?
|
Spreads by local extension to lymphatics or regional lymph nodes and hematogenously
|
|
|
What are the common sites of prostate cancer metastases?
|
Bone (most common)
Liver Lung |
|
|
What options are available for diagnosis and staging of prostate cancer?
|
-PE, PSA, TRUS, serum chemistries, bone scan, CT/MRI, biopsy
|
|
|
What are 2 ways to biopsy the prostate?
|
-Transrectal biopsy
-transurethral resection of the prostate (TURP) |
|
|
What is the Gleason grading system and how is it used?
|
Grades 2-10
-Scores 1-5: assigned to primary and secondary growth patterns and added together for Gleason score -Higher score signifies a greater probability of extracapsular spread |
|
|
What is signified by a score of 2-4 on the Gleason grading system?
|
Slow-growing, well differentiated tumors
|
|
|
What is signified by a score of 8-10 on the Gleason grading system?
|
Aggressive, poorly differentiated tumors
|
|
|
What should be considered when determining treatment for prostate cancer?
|
Stage and Grade
(also consider age, general health and preferences) |
|
|
What are the 5 treatment options for localized (Stages A & B) prostate cancer?
|
1. Expectant Management (EM)
2. Radiation Therapy (RT) 3. Radical Prostatectomy (RP) 4. Androgen Ablation (AA) 5. Antiandrogen Monotherapy |
|
|
What is monitored in EM?
|
PSA, DRE, and sx
|
|
|
When should treatment be initiated in EM?
|
Initiate treatment with rising PSA or development of sx
|
|
|
When is EM most appropriate?
|
For men with <10 years life expectancy and low grade disease
|
|
|
What are the advantages of EM?
|
Avoids immediate morbidity associated with tmt and maintains quality of life
|
|
|
What are disadvantages of EM?
|
Risk of progression, increased anxiety, requires frequent medical exams, subsequent tmt may be more intense
|
|
|
What types of RT are available for localized prostate cancer?
|
External Beam or Brachytherapy
|
|
|
True or False: RT is equivalent in outcome to surgery in localized (Stage A & B) prostate cancer
|
TRUE
(option for patients who are not surgical candidates) |
|
|
What are the complications of RT?
|
1. Impotence (30%)
2. Rectal/Bladder sx |
|
|
True or False: RP is definitive curative therapy.
|
TRUE: 85% of men with disease confined to the prostate cured at 10 years
|
|
|
What are complications of RP?
|
Early mortality, bladder contracture, incontinence, impotence
|
|
|
What should be added if RP and any N?
|
Add 3 months of adjuvant LHRH agonist
|
|
|
What is androgen ablation (AA)?
|
LHRH +/- antiandrogen or orchiectomy
|
|
|
What is the goal serum testosterone 1 month after initiation of AA?
|
< 20 ng/mL
|
|
|
What are the treatment options for locally advanced prostate cancer (Stage C - T3 & T4)?
|
1. Radiation Therapy +/- Neoadjuvant Hormonal Therapy
2. Radical Prostatectomy +/- Neoadjuvant Hormonal Therapy |
|
|
What are first line hormonal therapies for prostate cancer?
|
Orchiectomy or LHRH agonists
|
|
|
What is the result of orchiectomy?
|
-immediate drop in testosterone levels
|
|
|
What are the side effects of orchiectomy?
|
-impotence
-hot flashes |
|
|
What are the LHRH agonists?
|
1. Leuprolide acetate
2. Leuprolide depot and goserelin acetate implant 3. Triptorelin depot 4. Triptorelin LA injection |
|
|
What are the most common adverse effects of LHRH agonists?
|
- flare-up during first week
- hot flashes - impotence - decreased libido - injection site reactions |
|
|
What is a counseling point for patients receiving LHRH?
|
-worsening of symptoms during the first week of therapy
|
|
|
What treatment modification should be done for patients with overt metastasis to decrease tumor flare?
|
Antiandrogen should precede LHRH agonist and continue in combination for one month
|
|
|
What are the available antiandrogens?
|
1. Flutamide (Eulixin)
2. Bicalutamide (Casodex) 3. Nilutamide (Nilandron) |
|
|
True or False: Monotherpy with antiandrogens is more effective than LHRH agonist.
|
FALSE: less effective
|
|
|
For advanced prostate cancer, how are antiandrogens indicated?
|
Indicated only in combination with androgen-ablation therapy
|
|
|
True or False: Antiandrogens can reduce symptoms from flare phenomenon associated with LHRH therapy.
|
TRUE
|
|
|
Which antiandrogen can cause a dilsulfiram effect, decreased visual accommodation, and interstitial pneumonia (low rate)?
|
Nilutamide
|
|
|
What is CAB?
|
Combined Androgen Blockade (LHRH + AA)
-rationale for combined hormonal therapy is to interfere with multiple hormonal pathways to completely eliminate androgen action |
|
|
True or False: A high percentage of patients with advanced prostate cancer respond to initial CAB therapy.
|
True: about 80% respond to initial therapy
|
|
|
What are 2 mechanisms of resistance to CAB?
|
1. Tumor heterogeneous
- cells hormone-dependent - cells hormone-independent 2. Tumor could be stimulated by extratesticular androgens that are converted intracellularly to DTH |
|
|
When is CAB most beneficial?
|
Most beneficial for improving survival in patients with minimal disease and preventing tumor flare in advanced disease
|
|
|
What is the general recommendation for CAB?
|
-Some investigators consider CAB initial hormonal therapy for newly diagnosed
-All others start on LHRH monotherapy and add antiandrogen after several months if ablation is incomplete |
|
|
What are second line hormonal therapies for treating prostate cancer?
|
1. Antiandrogen withdrawal
2. Corticosteroids 3. Aminoglutethamide 4. Ketoconazole 5. Megestrol acetate 6. Diethylstlbestrol (DES) (withdrawn from market '98) 7. New approaches |
|
|
What is the standard second line hormonal therapy for prostate cancer?
|
*Antiandrogen Withdrawal*
MOA unknown |
|
|
What are the corticosteroids used for second line hormonal therapy treatment of prostate cancer and what is their MOA?
|
*Dexamethasone and Prednisone*
MOA: suppression of ACTH and subsequently adrenal androgens |
|
|
How does aminoglutethamide work and what are some adverse effects?
|
MOA: inhibits steroid synthesis in adrenal gland
AEs: CNS (confusion, depression, dizziness, ataxia), dermatologic (rash) |
|
|
What are the MOA and AEs of ketoconazole?
|
MOA: inhibits androgen synthesis in testes and adrenal glands
AEs: N/V, impotence, gynecomastia, dry skin, increased LFTs, hepatitis (rare) |
|
|
What 2 second line hormonal therapies for prostate cancer act on CYP450 pathway and require the replacement of corticosteroid with hydrocortisone?
|
Aminoglutethamide and Ketoconazole
|
|
|
What is the MOA and AEs of megestrol acetate?
|
MOA: inhibits release of LH, block androgen receptor, inhibits 5 alpha reductase activity
AEs: fluid retention and mild appetite stimulation |
|
|
What are 3 new approaches being investigated for second line hormonal therapy in prostate cancer?
|
1. antiandrogen monotherapy
2. sequential androgen blockade 3. intermittent androgen suppression |
|
|
What are the treatment options for Androgen Independent Prostate Cancer (AIPC)?
|
(Hormone Refractory)
1. Doxetaxel + Prednisone (TAX 327) 2. Mitoxantrone/Prednisone 3. Estramustine 4. Paclitaxel |
|
|
What 2 treatments are FDA approved for androgen independent prostate cancer (AIPC)?
|
1. Doxetaxel + Prednisone
2. Mitoxantrone/Prednisone |
|
|
What 2 radionuclides can be used to deliver localized radiation to osteoblastic bone lesions (bone metastasis)?
|
1. Strontium 89 (Metastron)
2. Samarium-153 (Quadramet) |
|
|
What is the major toxicity of radionuclides strontium 89 and samarium 153?
|
Myelosuppression
|
|
|
When is radiation therapy for palliation indicated in prostate cancer?
|
1. spinal cord suppression
2. impending fracture 3. localized soft tissue or bone disease |
|
|
What drug is indicated for prostate cancer with metastatic bone disease following progression after hormonal therapy?
|
Zolendronic Acid
|
|
|
When is zolendronic acid contraindicated?
|
SCr > 3mg/dL
|
|
|
What are the AEs associated with zolendronic acid?
|
-acute phase reactions, myalgias, anemia, anorexia and edema
|
|
|
How often is leuprolide acetate given?
|
Once daily
|
|
|
How often is leuprolide depot and goserelin acetate implant given?
|
Once monthly, every 12 weeks, or once every 16 weeks
|
|
|
What is the dose and how often is triptorelin depot given?
|
3.75mg once every 28 days
|
|
|
What dose and how often is Triptorelin LA injection given?
|
IM 11.25mg every 84 days
|
|
|
What antiandrogen has the longest half-life?
|
Bicalutamide - 1 week (given qd)
|
|
|
What antiandrogen has the shortest half-life?
|
Flutamide - 9.6 hours (given tid)
|
|
|
True or False: An informed consent should be obtained from patients before PSA screening.
|
TRUE: High rate of false positives; discuss risks and benefits
|
