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What is the initial mainstay for metastatic prostate cancer?
What is the MOA of the Luteinizing Hormone-Releasing Hormone agonists (LH-RH agonists)?
Downregulation of pituitary receptors and reduction in testosterone production
What are the Luteinizing Hormone-Releasing Hormone (LH-RH) agonists used in metastatic prostate cancer?
- Leuprolide (implant or depot)
- Triptorelin (implant or depot)
What is the salvage tx for pts who have progressed on CAB (combined androgen blockade)?
Remove the antiandrogen (this is called androgen withdrawal because it stops the antiandrogens from agonist action on mutated androgen receptors)
What is the tx for prostate cancer pts who progress on treatment/salvage tx?
- Androgen synthesis inhibitors:
- Docetaxel + Prednisone DOC
- Mitoxantrone + Prednisone
- Cabazitaxel + Prednisone (salvage for failure with Docataxel)
When should DRE + PSA screening begin for prostate cancer?
- Age 50 for men with normal risk
- Age 45 for men with high risk (black men and those with 1st-degree family hx)
- Age 40 for men with highest risk (1st-degree family hx at an early age)
What is the effect of bisphosphonates in prostate cancer patients?
decrease in skeletal related complications associated with bone metastases
What agents are used for chemoprevention of prostate cancer?
Finasteride (5-alpha reductase inhibitor)
Who can be offered chemoprevention for prostate cancer with a reasonable expectation of benefit?
those greater than 50yo with BPH
What is the MOA of antiandrogens?
Inhibition of androgen uptake and/or nuclear binding of androgen in target tissues
What are the antiandrogens used in metastatic prostate cancer?
What are the SE of the Luteinizing Hormone-Releasing Hormone (LH-RH) agonists?
- Hot flashes
- Erectile impotence
- Decreased libido
- Injection site rxns
- Disease flare-up (this occurs for the 1st week of tx)
What are the SE of the antiandrogens?
- Hot flashes
- LFT abnormalities
- Methemoglobinemia (Flutamide)
- Visual disturbances (Nilutamide)
- Alcohol intolerance (Nilutamide)
- Interstitial pneumonitis (Nilutamide)
What is the cheapest antiandrogen?
What is the most expensive antiandrogen?
What the most expensive Luteinizing Hormone-Releasing Hormone (LH-RH) agonist?
Leuprolide depot (implants are cheaper than depots)
When are non-pharmacological tx used for prostate cancer?
- When patients are asymptomatic, Gleason score 2-6, and PSA < 10ng/mL
- If life expectancy <10y, no surgery should be offered
What factors can change PSA levels in a pt?
- 6-12 mo tx with Finasteride, Dutasteride, and antiandrogens
- Acute urinary retention
- Acute prostatitis
- Prostatic ischemia
- Prostatic infarction
What is the normal level for PSA?
< 4 ng/mL