Prostate Cancer
What chemotherapy regimens are used for advanced prostate cancer?
1) Docetaxel and prednisone 2) Docetaxel and estramustine
Signs of symptoms of prostate cancer
A lot of the time prostate cancer is not accompanied by any specific signs or symptoms. Frequently symptoms of prostate cancer do not become evident until the disease is quite advanced. Symptoms of prostate cancer are usually similiar to those of benign prostate hypertrophy: decreased force of urine stream, urinary frequency, urinary urgency, nocturia, impotence, hesitancy when urinating, unable to empty the bladder completely, blood in the urine.
Side effects of bisphosphonates
Abdominal pain, dyspepsia, diarrhoea, constipation
Risk factors for prostate cancer
Advancing age; diagnosis usually occurs in men over the age of 65, benign prostate hypertrophy, family history of prostate cancer
Signs and symptoms of advanced metastasised prostate cancer
Back pain, anaemia, cord compression, weight loss, pathological fractures
MOA of cyclophosphamide
Cross linking within and between DNA strands, altering DNA bases and causing base mis pairing. Cytotoxic drug which kills tumour cells.
Plan for prostate cancer
Depending on how advanced the cancer is, the decision needs to be made between doctor and patient whether to treat or just monitor. Begin combination therapy of goserelin and flutamide. Flutamide should be started prior to therapy with goserelin in order to decrease/stop the tumour flare that is associated with LHRH agonists
What are 3 examples of LHRH/GnRH agonists?
Goserelin, triptorelin, leuprolide
Side effects of anti-androgen therapy
Gynceomastia (man boobs), nausea, vomitting, nausea, vomitting, diarrhoea, decreased libido.
Side effects of cyclophosphamide
Haemorrhagic cystitis, myelosuppresion
Diagnostic testing
PSA testing. If PSA is present in blood at >4ng/mL this could indicate cancer. DRE Digitial rectal examination- physical exam to feel for any abnormalities or changes to the prostate gland and transrectal ultrasound
Defintion/causes
Prostate cancer is a cancer that originates in the male prostate gland and is relatively slow growing cancer. The risk of prostate cancer increases with a man's age. Many males can have prostate cancer for many years, but show no signs or symptoms, so the decision can be made not to treat but to closely monitor its progression. Many men die with prostate cancer and not because of it
Complications of prostate cancer
Radiation therapy, surgery, metastasis, treatment failure, palliative care
What is the goal of treatment for prostate cancer?
The goal of treatment in early prostate cancer is to minimise morbidity and mortality due to prostate cancer
MOA of LHRH agonists?
These drugs are small synthetic molecules that are structurally similiar to endogenous LHRH. The body recognises that there is an increased level of LHRH in the body, and as a result LH is not stimulated to be produced from the pituitary therefore there is no production of testosterone. Testosterone therefore is unable to stimulate the growth of the prostate tumour.
MOA of bishophosphonates
These drugs can be used in the treatment of prostate cancer that has metasised to the bone. They are used to help reduce the symptoms and pain associated with the increased levels of circulating calcium due to the breakdown of bone as a result of the cancer. They are also beneficial in the fact that they can help strengthen the bones and therefore reduce pathological fractures in the patient.
Side effects of LHRH agonists?
Tumour flare syndrome- this is when LHRH is intially administered, it causes an increase in the levels of LHRH, leading to increased production of LH and testosterone so initially tumour can grow a little but this settles down. Other side effects include impotence, hot flushes, gynecomastia, nipple tenderness, depression or depression like symptoms.
Non-Pharmacological advice
advise patient to seek medical attention if there is any change to their condition or they begin experiencing new symptoms.
E.g.s of anti-androgen therapy
flutamide, nilutamide, bicalutamide
MOA of estramustine
inhibition of microtubules
MOA of docetaxel
interferes with normal function of microtubule growth
MOA of flutamide
these anti-androgen drugs work by binding directly to the testosterone receptors on the prostate cancer cells. With these receptors blocked, testosterone is unable to bind to the receptors and fuel the growth of the cancer cells. These drugs are very useful in combination with LHRH agonists, and if given prior to therapy with an LHRH agonist they can prevent the tumour flare.
