Prostate Cancer -- Oncology

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mp
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242179
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Prostate Cancer -- Oncology
Updated:
2013-10-22 18:10:14
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Prostate Cancer Oncology
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Prostate Cancer -- Oncology
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  1. Leuprolide (Lupron Depo, Eligard)
    • LHRH agonist
    • initial tumor flare (use an anti-androgen)
    • sleep disorders, sweating, hot flashes, pain, HA, QT prolongation (men in menopause)
  2. Goserelin (Zoladex) subQ implant
    • GnRH agonist
    • initial increase in LH and FSH
    • chronic admin. results in sustained suppression of pituitary gonadotropins
    • sleep disorders, sweating, hot flashes
  3. Triptorelin (Trelstar) IM
    • GnRH agonist
    • sleep disorders, sweating, hot flashes
  4. Degarelix (Firmagon) SubQ
    • GnRH antagonist -- binds reversibly to pituitary GnRH receptors, reducing release
    • hot flashes, increase in transaminases, inj site rxns
    • No initial flare, no anti-androgen needed
  5. Flutamide (Eulexin)
    • Anti-androgen -- inhibit androgen uptake and/or inhibits binding of androgens
    • CYP 3A4 or 1A2
    • hot flashes, CV disease, gynecomastia
    • Given TID -- comliance issues
  6. Bicalutamide (Casodex)
    • Anti-androgen -- androgen receptor inhibitor, specifically a competitive inhibitor for the binding of dihydrotestosterone and testosterone
    • gynecomastia, hot flashes, CV disease
    • PO Daily
  7. Nilutamide (Nilandron)
    • BBW for hepatic failure
    • disulfiram rxn, interstitial pneumonitis, visual adaptation delays
    • hot flashes, gynecomastia, CV problems
    • PO Daily
  8. Alternative Treatment options
    • Ketoconazole -- hydrocortisone replacement
    • Secondary hormone manipulation
    • Anti-androgen withdrawal
    • Aminoglutethimide
  9. Docetaxel
    • Microtubule inhibitor
    • Peripheral neuropathy, myelosuppression, alopecia, inj. site rxn
  10. Cabazitaxel (Jevtana)
    • Microtubule inhibitor
    • neutropenia, peripheral neuropathy, hypersensitivity rxn, GI syptoms (emesis)
    • Hormone refractory prostate cancer, after failure of Docetaxel regimine
  11. Sipuleucel-T (Provenge)
    • autologus CD54+ cells, administer doses in 2 week intervals for 3 doses (expensive)
    • premedicate with APAP and Benadryl
    • metastatic hormone refractory prostate cancer with minimal/no symptoms
  12. Enzalutamide (Xtandi)
    • Anti-androgen -- pure androgen receptor signaling inhibitor, no known agonistic properties
    • Seizures, gynecomastia, hot flashes, CV disease
    • Metastatic, castrate resistant prostate cancer previously treated with Docetaxel
    • DDI: 2C8, 3A4
  13. Abiraterone (Zytiga)
    • Selectively and irreversibly inhibits CYP17, inhibits formation of testosterone precursors DHEA and androstenedione
    • Metastatic, CRPC, who have failed docetaxel
    • Food increases AUC 10 fold
  14. Very low risk for recurrence
    • life expectancy <20 years = active surveillance
    • life expectancy >20 years = active surveillance, radiotherapy, or radical prostatectomy
  15. Low risk for recurrence
    • LRPC  and life expectancy <10 years = active surrveillance
    • LRPC and life expectancy > 10 years = radical prostatectomy +/- PLND
    • life expectancy >15 years = RT, surgery, brachytherapy
  16. Low risk for recurrence criteria
    • Tumors T1 to T2a
    • Gleason score <= 6
    • Serum PSA <= 10 ng/ml
  17. Intermediate risk for recurrence criteria
    • Any T2b-T2c
    • Gleason score of 7
    • PSA of 10-20 ng/ml
    • Any patient with 1 or more is High Risk
  18. Intermediate risk for recurrence
    • IRR + < 10 years life expectancy = AS or RT may also add ADT for 4-6 months
    • IRR + > 10 years life expectancy = RT, radical prostatectomy + PLND, 4-6 months of ADT; can use brachytherapy but not alone
  19. High risk for recurrence criteria
    • T3a
    • Gleason score 8-10
    • PSA >20 ng/ml
    • Any patient with 1 or more is Very Hign Risk
  20. High risk for recurrence
    • HRR should be treated unless life expectancy is <5 years
    • HRR treatment with RT + ADT (2-3 years)
    • RT + Brachytherapy + ADT (Primary tx option)
    • Radical prostatecotmy + PLND
    • NO ADT alone
  21. Very High risk for recurrence
    • T3b to T4
    • COmbo RT + Long term ADT
    • Combo Rt + brachytherapy +/- ADT
    • Radical prostatectomy + PLND
    • ADT
  22. Metastatic Disease
    • ADT
    • RT + neoadjuvant/concomitant/adjuvant ADT (2-3 years)
    • ADT is recommened for all pts with M1 disease

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