Prostate Cancer

What are the major risk factors for prostate cancer?

Advanced age, African American race, family history, BRCA1/2

What hormone stimulates prostate cancer growth?

Testosterone

What is the primary screening test for prostate cancer?

PSA

What PSA level suggests possible prostate cancer?

>4 ng/mL

When should average-risk men discuss prostate screening per ACS?

Age 50

What is the main controversy surrounding PSA screening?

False positives and unnecessary testing

What symptoms suggest bladder outlet obstruction?

Hesitancy, nocturia, incomplete emptying

What confirms prostate cancer diagnosis?

Biopsy with histopathology

What is TRUS used for?

Visualizing prostate and guiding biopsy

What does a higher Gleason score indicate?

More aggressive cancer

What Gleason score and PSA indicate low-risk prostate cancer?

Gleason ≤6 and PSA

What PSA range suggests intermediate risk?

10-20 ng/mL

What PSA level suggests high-risk prostate cancer?

>20 ng/mL

What Gleason scores indicate very-high-risk disease?

9-10

What does N1 indicate in prostate cancer?

Regional lymph node involvement

What does M1 indicate?

Distant metastasis

What are the goals of treatment in localized disease?

Potential cure while minimizing morbidity

What are the goals of treatment in advanced disease?

Symptom control and quality of life

What is active surveillance?

Frequent monitoring without immediate treatment

Which patients are candidates for active surveillance?

Low-risk localized disease

What are the main localized prostate cancer treatments?

Active surveillance, radiation, surgery

What are two types of prostate radiation therapy?

External beam radiation and brachytherapy

What are major radiation toxicities?

Urinary, bowel, and sexual dysfunction

What are major radical prostatectomy toxicities?

Urinary and sexual dysfunction

What treatment is recommended for intermediate-risk localized disease with longer life expectancy?

RP or RT with or without ADT

What treatment is used for high-risk or locally advanced disease?

RP or RT plus ADT

What is the initial treatment strategy for regional disease?

ADT ± abiraterone/prednisone ± RT

What is the foundation of metastatic prostate cancer treatment?

ADT

What is the target castrate testosterone level?

What is castration-sensitive prostate cancer?

Cancer that still responds to androgen deprivation

What is castration-resistant prostate cancer?

Progression despite castrate testosterone

Should ADT continue after castration resistance develops?

Yes

What is PSA persistence?

PSA remains detectable after local treatment

What is PSA recurrence?

PSA rises after treatment

Name three GnRH agonists.

Leuprolide, goserelin, triptorelin

How do GnRH agonists reduce testosterone?

Chronic pituitary receptor downregulation

What major initial complication occurs with GnRH agonists?

Tumor flare

What medication can prevent GnRH agonist tumor flare?

Bicalutamide

Name two GnRH antagonists.

Degarelix and relugolix

How do GnRH antagonists reduce testosterone?

Direct pituitary GnRH receptor blockade

Which GnRH class avoids tumor flare?

Antagonists

Which hormonal class is useful for rapid suppression during spinal cord compression?

GnRH antagonists

What are common adverse effects of ADT?

Hot flashes, gynecomastia, bone loss

What should be monitored during GnRH agonist treatment?

PSA, testosterone, bone mineral density

What is bicalutamide's mechanism?

Androgen receptor blockade

Should first-generation antiandrogens be used alone in untreated prostate cancer?

No

Name three second-generation androgen receptor antagonists.

Enzalutamide, apalutamide, darolutamide

What second-generation antiandrogens are listed for nonmetastatic CRPC?

Apalutamide, darolutamide, enzalutamide

What treatment is added to ADT in metastatic castration-sensitive disease?

Abiraterone/prednisone, apalutamide, enzalutamide, or docetaxel-based intensification

What is abiraterone's mechanism?

CYP17 inhibition

What three toxicities indicate abiraterone-related mineralocorticoid excess?

Hypertension, hypokalemia, edema

Why is prednisone given with abiraterone?

Minimizes mineralocorticoid excess

What labs and vitals are monitored with abiraterone?

LFTs, potassium, glucose, blood pressure

What is the preferred chemotherapy listed for metastatic disease?

Docetaxel plus prednisone

What chemotherapy is used after docetaxel resistance?

Cabazitaxel

What prostate cancer biomarker indicates PARP-directed therapy?

BRCA1/2 mutation

Name three PARP inhibitors from Smith's lecture.

Niraparib, olaparib, rucaparib

What biomarker indicates pembrolizumab?

MSI-H/dMMR

What antigen does sipuleucel-T target?

Prostatic acid phosphatase (PAP)

What metastatic complication may be treated with radium-223?

Bone metastases

What bone agents reduce skeletal-related events in metastatic CRPC?

Denosumab and zoledronic acid

What is Prolia's dose for ADT-induced bone loss?

60 mg SQ every 6 months

What is Xgeva's dose for bone metastases?

120 mg SQ every 4 weeks

What are major adverse effects of bone-modifying agents?

Hypocalcemia, osteonecrosis of jaw, muscle pain

What is alendronate's dose for ADT-induced bone loss?

70 mg orally weekly

What is zoledronic acid's listed dose for bone metastases?

4 mg IV every 3-4 weeks

Are finasteride and dutasteride recommended for prostate cancer chemoprevention?

No

Why are 5-alpha-reductase inhibitors not recommended for chemoprevention?

Concern for high-grade prostate cancer

What trials evaluated finasteride and dutasteride for prostate cancer prevention?

PCPT and REDUCE