Diagnostic Dilemma
This is the Gleason Score at which the diagnosis of cancer is made.
What is a Gleason score of 6?
Cancer has = 6 or more; 7 - intermediate, 8 is more likely to spread
This is the management for low risk prostate cancer.
Active surveillance (preferred) vs radical prostatectomy vs radiation
The ENZAMET, TITAN, STAMPEDE, and LATITUDE (among others) showed benefit of these class of medications in the treatment of metastatic prostate cancer.
What are second generation anti-androgens?
This is the difference between surveillance and active surveillance.
Active Surveillance Program includes the following:
--PSA no more often than every 6 months unless clinically indicated
--DRE no more often than every 12 months unless clinically indicated
--Repeat prostate biopsy no more often than every 12 months unless clinically indicated
--Consider repeat multiparametric (mp) MRI no more often than every 12 months unless clinically indicated
This is given 1-2 weeks prior to LHRH agonists to prevent flare
Bicalutamide
A prostate tumor that extends through the prostatic capsule is considered this T stage.
What is T3?
T1 - not visible by imaging
T2 - tumors within prostate
A - less than half a lobe
B - more than half a lobe
C - involves both labs
T3 - extends through prostatic capsule
T4 - fixed or invades adjacent structures
This is the cohort of localized prostate cancer who can get abiraterone.
What is very high risk prostate cancer and regional lymph node disease
The HERO trial showed that this medication in comparison to Lupron may have less cardiovascular side effects?
What is relugolix?
This is the definition of high volume disease in prostate cancer.
What is 4 or more bone metastases, with at least one metastases beyond the pelvis-vertebral column?
This is the mechanism of action of degarelix/relugolix
These are the intermediate risk prostate cancer factors.
What are are T2B, Grade group 2 or 3 (Gleason score 7, 3+4, or 4+3 respectively), or PSA > 10-20?
Unfavorable intermediate risk: 2 or 3 intermediate risk factors, grade group 3, > 50% of core biopsy positive
This is the risk level of prostate cancer at which one starts ADT.
What is unfavorable intermediate risk prostate cancer (and higher)?
The TALAPRO -2 study approved this medication in combination with enzalutamide for patients with HRR genes (ATM, ATR, BRCA1, BRCA2, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, or RAD51C).
What is talozaparib?
Note: Olaparib and Rucaparib MUST have a BRCA mutation (PropEL study in combo with abiraterone/prednisone)
This is the surveillance strategy for prostate cancer after definitive local treatment
What is PSA 6-12 months for 5 years, then once per a year with DRE?
This medication makes one more prone to seizures and falls.
What is enzalutamide?
Apalutamide also risky to give with patients with seizure hx
These are situations in which one should obtain a bone scan
What is
1) Unfavorable intermediate disease
2) High risk disease (T3a or Grade Group 4 or 5 or a PSA >20 ng/mL)
3) Very high-risk disease
One should expect this diagnosis in patients who have low PSAs and very high burden of disease and possibly visceral crises.
What is small cell of the prostate?
If small cell/neuroendocrine prostate cancer is diagnosed, one can offer Cisplatin/Etoposide, Carboplatin/Etoposide, Carboplatin/Cabazitaxel and Carboplatin/Docetaxel as therapy
The PEACE-1 and ARASENS trials approved these drugs for triplet therapy in combination with docetaxel and ADT for high volume castrate sensitive prostate cancer?
What are abiraterone and darolutamide?
This is the definition of biochemical recurrence after radiation therapy.
What is a serum PSA level that has increased by 2ng/dL above the nadir PSA value after RT (though may transiently increase after RT because of recovery of testosterone after ADT and/or from “PSA bounce” by prostate inflammation in the months after RT (18-24 months)?
These are the side effects of abiraterone.
What are HTN, CHF, atrial fibrillation, hypokelamia, lower extremity edema, CYP inhibition
This is the risk stratification for very high risk prostate cancer.
What is 2 of the following:
cT3/T4, Grade Group 4 (Gleason 8) or 5 (Gleason 9-10), or PSA > 40
HIGH Risk - one of the following
cT3a, Grade Group 4/5, PSA > 20
This medication is approved for patients with metastatic castrate resistant prostate cancer with asymptomatic bone metastases and no visceral metastases
What is Sipuleucel-T?
Radium 223 is for SYMPTOMATIC bone metastases
What is PLUVICTO?
177Lu-PSMA-617 plus standard care significantly prolonged, as compared with standard care, both imaging-based progression-free survival (median, 8.7 vs. 3.4 months; hazard ratio for progression or death, 0.40; P<0.001) and overall survival (median, 15.3 vs. 11.3 months; hazard ratio for death, 0.62; 95% CI, 0.52 to 0.74; P<0.001).
This is the definition of PSA Persistence after radical prostatectomy
This is the definition of PSA Persistence after radical prostatectomy
This is when you should offer bisphosphonates/denosumab to prostate cancer patients.
What is when they become castrate resistant or found to have osteoporosis on initial bone scans?