ADV Therapeutics: Prostate Cancer
Treatment for Prostate Cancer:
1. observation (more so for older, if can't tolerate chemo 2. active surveillance- watch more closely **with these two, you would not see that in other cancers - won't treat prostate cancer until symptomatic 3. surgery 4. radiation (brachytherapy) 5. androgen Deprivation therapy (ADT) b/c cancer is fed by testosterone -GnRH analogs -Antiandrogens 6. cytotoxic chemotherapy
What are the signs and symptoms of prostate cancer?
1. ***usually only present in advanced disease, looks a lot like BPH 2. weak or interrupted urine flow 3. difficulty starting/stopping flow 4. polyuria 5. pain or burning with urination 6. blood in the urine 7. anemia, weakness, or weight loss 8. pain in the spine, hips, ribs, or other bones 9. weakness or numbness in legs or feet 10. loss of bladder control or bowel control
What happens with observation and Active surveillance ?
1. Active surveillance - PSA every 6 months, DRE atleast once a year + prostate biopsies and imaging every 1-3 years 2. observation-meant to control symptoms, less intensive (fewer tests)
What are the risk factors of prostate cancer?
1. Age **=men older than 65 (usually rare before age 50) 2. family history (first degree relative, risk is doubled if its father or brother) 3. Race-more common in AA 4. DIET?? -red meat, high fat dairy products, few fruits and veggies 5. No increased risk with obesity and smoking
GnRH Analogs (Agonist + Antagonist: Name the drugs) Explain why and how they do the same thing? ADE?
1. Agonists: Leuprolide (IM/SQ), Goserelin (SQ), triptorelin (IM), Histrelin (SQ) 2. Antagonist: Degarelix (SQ) monthly 3. ADE: - HOT FLASHES (b/c deprive body of hormone), ED, FATIGUE, MAN BOOBS, weight gain, pain at injection site, tumor flare (with agonists), QT prolongation ***the agonists increase the receptor and increase the amount of testosterone then shut down the pathway indirectly, while antagonists directly affect LH to shut down the pathway
Anti-androgens that affect testosterone receptors: List drugs
1. Bicalutamide 2. Enzalutamide 3. Apalutamide 4. Darolutamide 5. Abiraterone (CYP17)
what drugs are given for Bone metastases?
1. Bisphosphonates + Calcium/vit D -Pamidronate -Zoledronic Acid 2. RANKL with Calcium/vit D -Denosumab **can be given with chemo or hormonal therapy
What is given for spinal cord compression?
1. Dexamethasone -standard and try to stabilize spinal cord (longer it happens = more damage)
Spinal Cord Suppression: Emergency what happens?
1. acute compression= inflammation and vasogenic edema
How does spinal compression present?
1. back pain *** 2. weakness 3. sensory impairment 4. autonomic dysfunction -urinary hesitance/retention, constipation 5. loss of bowel or bladder function **
Where to breast and prostate cancer metastisize to?
1. bone
what do anti-androgens do?
1. competitively inhibit the binding and uptake of testosterone and DHT to androgen receptors 2. can be used with GnRH analogs for complete androgen blockage
ADT Therapy does what?
1. decreases androgen production or its' activity on the androgen receptor 2. does not cure by itseld 3. Castration -orchiectomy=remove testes -LHRH analogs= GnRH analogs (Leurpolide) which will cut off the signaling to make testosterone -Anti-Androgens=affects the receptors (deprive the receptors + need with another one of these therapies due to the feedback look
What are the ADE of Docetaxel?
1. fatigue 2. neuropathy ( M phase) 3. stomatitis 4. diarrhea 5. myelosuppression
Where the ADE of Cabazitaxel?
1. febrile neutropenia 2. severe diarrhea 3. fatigue 4. CINV 5. anemia 6. thrombocytopenia
what are the side effects of anti-androgens?
1. heptotoxicity 2. diarrhea 3. man boobs 4. fewer sexual AEs if monotherapy, but combo can cause ED
what are the ADE of Bone metastases meds?
1. skeletal related events-bone degeneration and break 2. Osteronecrosis of the jaw
After combo therapy of hormones have been tried, switch to chemo, what is used?
1. taxanes