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18 Cards in this Set
- Front
- Back
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Prostate Cancer: Risk Factors
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1) African Americans
2) Age > 65 y/o |
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Testosterone Production?
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Testes: 95%
Adrenal Glands: 3% – 5% |
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Orchiectomy Advantages:
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Rapidly reduces circulating androgens to castrate levels < 50 ng/dL
Prolongs survival |
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Tumor Flare?
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The most common adverse effect reported with LH-RH agonist therapy including a disease flare up during the first week of therapy
cause by initial induction of LH and FSH by the LH-RHY agonist and manifests clinically as either bone pain or increased urinary symptoms |
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Tumor Flare Blocked by:
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Antiandrogens
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LHRH Agonists: Side Effects
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Impotence
Decr. Libido Hot Flashes Bone Loss (Osteoporosis) |
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LHRH Agonists: Dosage
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Leuprolide depot 7.5 mg/month
Leuprolide 4 month 30mg/16week Leuprolide 3 month 22.5mg/12week Leuprolide daily 1 mg SQ daily Goserelin 3.6 mg q 28 days / 10.8 mg q 12 wks |
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Antiandrogens: Drugs
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Flutamide
Biclutamide (Casodex) Nilutamide |
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Antiandrogens: Drug Dosages
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Flutamide 250mg po tid
Biclutamide(Casodex)50mg po qd Nilutamide 300mg po qd x1month then 150 mg po qd |
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Antiandrogens: Treatment of choice
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• Combination of anti-androgen and LHRH agonist
• Efficacy over 80-90 %, most relapse within 2 years • Prolonged survival seen with initial combination therapy • Mean Survival 35.6 months with combination vs. 28.3 months with LHRH agonist alone |
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Antiandrogens: Hormone withdrawal
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Mutations in the androgen receptor have been demonstrated allowing anti-androgens to become agonists and activate androgen receptors. Pt’s responses to withdrawal manifest as significant PSA reductions and improved clinical symptoms.
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Antiandrogen Side Effects
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Impotence / Decreased libido
Hot flashes N/V LFT abnormailities GI Pain Gynecomastia Dirrhea (Flutamide) |
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Chemotherapy in Prostate
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Mitoxantrone + Prednisone with decr. pain score but no impact on survival
Estramustine + Docetaxel |
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Medical Adrenalectomy
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Ketoconazole 400 mg po q8h
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Estrogen therapy
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CV events (MI)
PE, DVT!! ETC. VERY DANGEROUS |
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Current Strategy for Hormonal Therapy:
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Orchiectomy and monitor PSA for dropping. Other tx if rising
LHRH+Antiandrogen FRONTLINE (efficacy 80-90% with relapse in 2 yrs) |
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Risks for Tumor Flair
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Is tumor in spinal cord or close to blocking off kidney's with risk of blocking kidney's
NO then LHRH alone OK |
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Herbal Therapy:
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PC-Spes (Canada / Mexico) Removed from market b/c FDA issues
DHEA (Testosterone Derivitave and dangerous) Saw Palmetto (5-alpha reductase activity) for BPH no effect in prostate cancer Lycopene (Prevention reported with high tomato intake) |
