Prostate Cancer
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1
What do most prostate cancer treatments do?
Supress testosterone
2
What percent of testosterone do the testes and adrenal glands make?
95% and 5% respectively
3
What other source of testosterone might there be in prostate cancer patients?
Prostate cancer cells can sometimes start producing testosterone
4
What is PSA?
Prostate specific antigen, an antigen produced by prostate cells that can be a useful marker for the prescence of prostate cancer or progession of disease
5
What PSA is found in healthy people?
<4ng/mL, a level of 4-10 suggests they may have prostate cancer
6
What is the ideal PSA for someone with prostate cancer that is being treated
Undetectable
7
Prostate cancer risk factors
65+ years old
black men
genetic- family history and germline mutations
black men
genetic- family history and germline mutations
8
When to generally start talking about prostate cancer screening?
50 years old, 40 if high risk
PSA test every 1-4 years
PSA test every 1-4 years
9
What to do if a patient is on ADT and their PSA continues to rise?
If the doubling time is >10 months, observe, if it is <10 months, start a second generation antiandrogen
10
What is the gold standard for castration niave metastatic prostate cancer?
ADT + chemotherapy with docetaxel + anti-hormonal therapy with abiraterone acetate or darolutamide
11
What to do for castration resistance metastatic prostate cancer?
Continue ADT
evaluate tumor for mutations
add additional therapy depending on tumor type, makup, and metastatic site
palliative radiation therapy
supportive care
evaluate tumor for mutations
add additional therapy depending on tumor type, makup, and metastatic site
palliative radiation therapy
supportive care
12
What are the LHRH agonists?
Leuprolide
Goserelin
Triptorelin
Goserelin
Triptorelin
13
What are the LHRH antagonists?
Degarelix
Relugolix
Relugolix
14
What drug is given when starting an LHRH agonist to avoid complications with initial GNRH stimulation?
Biclutamide, a first generation anti-androgen
15
What are the second generation antiandrogens?
Darolutamide
Apalutamide
Enzalutamide
Apalutamide
Enzalutamide
16
What are abiraterone acetate's brand names and what to know about them?
Zytiga, given on an empty stomach with prednisone
Yonsa (micronized form), given with no food restrictions and methylprednisolone
Yonsa (micronized form), given with no food restrictions and methylprednisolone
17
What to avoid giving with radium 223?
Abiraterone
18
Osteoperosis high risk prostate cancer treatments?
Denosumab (Prolia) 60mg SQ q 6 months
Zolendronic acid (Reclast) 5mg IV yearly
Alendronate (Fosamax) 70mg PO weekly
Zolendronic acid (Reclast) 5mg IV yearly
Alendronate (Fosamax) 70mg PO weekly
19
Drugs to give for castrate resistance bone metastatic prostace cancer?
Zolendronic acid (Zometa) 4mg IV over 15 minutes every 3-4 weeks
Denosumab (Xgeva) 120mg SC q 4 weeks
Denosumab (Xgeva) 120mg SC q 4 weeks
20
What are potential drugs for hot flashes?
Paroxetine or clonidine
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