Prostate Cancer

GB is a 72-year-old male with a past medical history of seizures. He is a newly diagnosed metastatic castrate-resistant prostate cancer patient. Which of the following regimens is most appropriate for this patient? A. Abiraterone + Leuprolide B. Enzalutamide + Leuprolide C. Apalutamide D. Darolutamide

A. Abiraterone + Leuprolide may be utilized in this patient as there is no seizures contraindication and this regimen is now recommended as a first-line option in metastatic castrate-resistant prostate cancer. Enzalutamide, apalutamide, and darolutamide have seizure risks.

LN is starting on docetaxel for his metastatic castrate-resistant prostate cancer. Which of the following side effects should LN expect? A. Alopecia B. Hot flashes C. Hypertension D. Seizures

A. Alopecia is a primary side effect of docetaxel chemotherapy. Hot flashes, hypertension, and seizures are side effects of the other options for systemic therapy.

JR is a 71-year-old male who has been on Leuprolide and Bicalutamide for almost 6 months for his prostate cancer. Today, his PSA has been slowly increasing over the last 6 months from 10 to 40 ng/mL (mcg/L), and he admits to having more urinary symptoms. Which of the following strategies would you recommend? A. Discontinue bicalutamide B. Add flutamide C. Add nilutamide D. Discontinue leuprolide

A. Antiandrogen withdrawal, for patients having progressive disease while receiving combined androgen blockaded with leuprolide and bicalutamide, can provide additional symptomatic relief. Therefore, discontinuing bicalutamide may be a great strategy.

GS is a newly diagnosed prostate cancer patient being treated with androgen deprivation. Which of the following are appropriate counseling points for a new patient starting on an LH-RH agonist? A. Patient may experience side effects such as a loss in libido, hot flashes, and impotence B. Patient may experience changes in blood pressure C. Patient may experience side effects such as nausea/vomiting, alopecia, and weight loss D. Patient may experience arthralgias, peripheral edema, and seizures

A. LHRH agonists cause adverse effects such as a loss in libido, hot flashes, and impotence. The other side effects are associated with some of the other therapies including docetaxel, abiraterone, and enzalutamide.

Which of the following Gleason scores is considered the most aggressive? A. 3+3 B. 4+5 C. 3+4 D. 4+4

B. A Gleason score of 4+5 for a total score of 9 is considered poorly differentiated and is considered aggressive.

Which of the following medications should be taken on an empty stomach due to an increase in bioavailability when taken with food? A. Bicalutamide B. Abiraterone C. Enzalutamide D. Apalutamide

B. Abiraterone should be taken on an empty stomach as food increases the bioavailability by 10-fold

A patient presents to your clinic with new onset metastatic castrate-resistant prostate cancer with bone metastases. He is initiated on docetaxel for 6 cycles. He is complaining about significant back pain. Which of the following would you recommend? A. Sipuleucel-T B. Radium-223 C. Abiraterone D. Enzalutamide

B. Radium-223 can be administered to target specific bone metastases with alpha particles in patients with metastatic castrate-resistant prostate cancer. In clinical trials, opioid needs were reduced in addition to improvement in skeletal pain, pain-related outcomes, and quality of life.

Which of the following is the most common site of metastases for prostate cancer? A. Brain B. Bone marrow C. Bone D. Heart

B. The bone is the most common site of metastases for prostate cancer.

SS is a 52-year-old man with a history of BPH. His most recent DRE was normal, but his last PSA was 5.1 ng/mL (mcg/L). JJ is concerned about getting prostate cancer and wants to discuss preventative therapy. Which of the following statements is true based on the recent chemoprevention data? A. 5-α-reductase inhibitors are no longer recommended for chemoprevention B. Abiraterone has been shown to decrease the incidence of prostate cancer in high-risk patients C. 5-α-reductase inhibitors decrease prostate cancer but increase the Gleason score in patients who develop cancer D. Abiraterone is no longer recommended for chemoprevention

C. 5-α-reductase inhibitors decrease the risk of prostate cancer, but increase the Gleason score in patients who develop cancer. Therefore, in patients who develop prostate cancer, their tumor is more aggressive.

4. Which of the following systemic therapies is associated with hot flashes? A. Docetaxel B. Cabazitaxel C. Bicalutamide D. Sipuleucel-T

C. Bicalutamide along with the other first-generation antiandrogens are associated with hot flashes.

Which of the following agents is considered a second-generation antiandrogen? A. Bicalutamide B. Ketoconazole C. Enzalutamide D. Abiraterone

C. Enzalutamide is considered a second-generation antiandrogen. Ketoconazole and abiraterone are considered androgen synthesis inhibitors. Bicalutamide is a first-generation antiandrogen.

BB is a 61-year-old man with nonmetastatic castrate-resistant prostate cancer. He has failed multiple lines of therapy. He also has several other comorbid diseases including chronic heart failure (CHF) and diabetes. Which of the following systemic agents is the most appropriate for this patient? A. Abiraterone + Leuprolide B. Bicalutamide C. Nilutamide D. Apalutamide + Leuprolide

D. Apalutamide is indicated for nonmetastatic castrate-resistant prostate cancer in combination with androgen deprivation therapy to maintain testosterone levels <50 ng/dL (1.7 nmol/L).

MN is a 72-year-old man who was recently diagnosed with prostate cancer and is initiated on a hormone agent for the first time for androgen deprivation. Which of the following agents will result in castration levels within 7 days? A. Leuprolide B. Goserelin C. Triptorelin D. Degarelix

D. Castration levels are achieved in 7 days or less with degarelix, as compared with 28 days with leuprolide, goserelin, and triptorelin.

Denosumab, a RANK-ligand inhibitor, is now recommended in prostate cancer patients for the prevention of skeletal-related events while on androgen deprivation therapy. Which of the following side effects may occur with denosumab? A. Hypertriglyceridemia B. Hypertension C. Hypercalcemia D. Osteonecrosis of the jaw

D. Osteonecrosis of the jaw is an adverse effect of both denosumab and bisphosphonates.

Which of the following regimens is indicated for minimally symptomatic metastatic castrate-resistant prostate cancer? A. Enzalutamide B. Apalutamide C. Radium-223 D. Sipuleucel-T

D. Sipuleucel-T, an autologous cellular immunotherapy, is indicated for minimally symptomatic