Prostate cancer and antieoplastic agents

Be familiar with the following agents:

• GnRH analogs (LH-RH)

• GnRH (LHRH) antagonists

• First generation antiandrogen

• Second generation antiandrogen

• Androgen. metabolism inhibitor (CYP 17 Inhibitors)

• Chemotherapy

• Check point inhibitors

• PARP inhibitors

• Sipuleucel-T

• Radiopharmaceutical therapy

Prostate physiology

RFs

• What gender, age, race, diet

Screening and prevention

Average-risk men 45–74 years

💬 Talk with your doctor about screening

Together, decide if screening is right for you based on your preferences and risks.

High-risk men 40–75 years (African ancestry, inherited gene mutation, or strong family history)

💬 Start the discussion earlier

These men have a higher chance of developing prostate cancer, so earlier screening may help.

Chemoprevention

• what agents is not recommended to use for the reduction of prostate cancer risk

  • when should they be prescribed

Do not prescribe finasteride or dutasteride solely to prevent prostate cancer.

Do prescribe them when indicated for BPH, where their benefits clearly outweigh the risks.

Prostate Specific Antigen (PSA)

• Is this a reliable test

• what agents decrease PSA

PSA

• High PSA

  • Inconclusive cutoff

• High PSA does not automatically mean prostate cancer - needs further testing

PSA doubling time (PSADT)

Prostate-Specific Membrane Antigen (PSMA)

• a target for advanced imaging techniques such as PSMA PET scans, which help detect prostate cancer spread more accurately than conventional imaging

• therapy

WHat is a gleason score

What is the staging of prostate cancer based on

Management and treatment of prostate cancer depends on what factors

Monitoring - active surveillance vs observation

Androgen deprivation therapy (ADT) - Castration therapy

• when is this indicated

ADT - Castration therapy

• testosterone level monitoring

• whats less effective

• combination

ADT - Castration therapy

• what agent is discouraged

• risks with ADT

• Osteoporosis prevention

• Risks

Continuous ADT (CAD) Vs IAD (intermittent ADT)

HRD and BRCA

Castration-Sensitive NonMetastatic (M0) PC

Castration-Sensitive Metastatic (M1) PC

NonMetastatic Castration-Resistant (M0) PC

Metastatic Castration-Resistant (M1) PC

LHRH agonists = GnRH agonists

LHRH (GnRH) agonists

• MOA Males v Females

Leuprolide

• Indication

• Routes of admin

• Admin time

Leuprolide

• Potential ADRs and Supportive Care

Leuprolide

• DDIs

• Monitoring

• Clinical pearls

LHRN (GnRH) Antagonists

• Agents

• MOA

Anti-androgens

• how do 1st and 2nd generation agents differ

• handling

• partners

Abiraterone

• MOA

• effects of glucocorticoids

• effects of mineral-corticoids

Abiraterone

• Indication

• Admin

• Dosing

Abiraterone

• major ADRs

Abiraterone

• DDI

• Monitoring

Pembrolizumab and PARP inhibitors