prostate cancer€¦ · 11/09/2017 · which of the following is not a risk factor for prostate...
TRANSCRIPT
![Page 1: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/1.jpg)
ProstateCancer
Dr.AndresWiernik2017
![Page 2: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/2.jpg)
Objectives
YES!!!1. Epidemiology2. BiologyorNaturalHistoryofProstateCancer3. Treatment
NO!!!1. ProstateCancerScreening- controversies
![Page 3: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/3.jpg)
Whichisthemostcommoncancerdiagnosedinmen?
1. Lung2. Prostate3. Colon4. Pancreas5. Lymphoma
![Page 4: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/4.jpg)
What%ofnewlydiagnosedProstateCancerpatientsarealiveat5years?
1. 5%2. 25%3. 50%4. 75%5. 99%
![Page 5: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/5.jpg)
WhichofthefollowingisNOTariskfactorforProstateCancer?
• Ageover50• African-American• FatherwithhistoryofProstateCancer• VitaminEsupplementation• Finasteride
![Page 6: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/6.jpg)
Epidemiology
![Page 7: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/7.jpg)
ProstateCancer2014
![Page 8: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/8.jpg)
ProstateCancer2016
![Page 9: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/9.jpg)
ProstateCancer2016
![Page 10: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/10.jpg)
ProstateCancer2016
![Page 11: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/11.jpg)
ProstateCancer2016
![Page 12: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/12.jpg)
ProstateCancer2016
![Page 13: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/13.jpg)
ProstateCancer2016
![Page 14: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/14.jpg)
ProstateCancer2016
![Page 15: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/15.jpg)
RiskFactorsforProstateCancer
• Gender• Age• Race• FamilyHistory (father,brotherorson)• Hormones• VitaminEsupplementation
![Page 16: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/16.jpg)
• 35533menin427sitesinUSA,CanadaPuertoRico• PSAlessthan4ng/mL• 55orolder(50orolderifBlack)
• 4arms:• Selenium200ug/day• Vit E400IU/day• Vit E+Selenium• Placebo
Followedfor7-12years
![Page 17: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/17.jpg)
p =0.008
VitaminEvs Placebo
![Page 18: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/18.jpg)
“Dr.Wiernik– isthereanythingIcantaketopreventProstateCancer?”
GnRH
5AlphaReductase INHIBITOR
Finasteride
![Page 19: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/19.jpg)
TheProstateCancerPreventionTrialFinasteride vs Placebo
NEJM– Aug2003
![Page 20: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/20.jpg)
NEJM– Aug2013
![Page 21: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/21.jpg)
Finasteride asCancerPrevention
• IdoNOTrecommendFinasteride forprostatecancerprevention
![Page 22: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/22.jpg)
BiologyandNaturalHistoryofProstateCancer
![Page 23: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/23.jpg)
DiagnosisofProstateCancer
• Localizeddisease(orlocallyadvanced)• 90-95%
• MetastaticDisease– StageIV• 5-10%
![Page 24: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/24.jpg)
ProstateCancer2016
![Page 25: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/25.jpg)
Case:ClassicClinicPatientMr.Cisa55-year-oldAfricanAmericanmalewhoyouseeinclinic
• BMI35kg/m2
• PSA2yearsagowas4ng/mL,now8 ng/mL• Asymptomatic• Comorbidities:hypertensionanddiabetes• Digitalrectalexamshows30-gramprostatewithoutnodules• APelvicMRIshowsevidenceof
• T1lesion• NoLNinvolvement
![Page 26: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/26.jpg)
![Page 27: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/27.jpg)
Case:Mr.C
• BiopsyResults• Gleasonscore:4+4=8/10,4of4coresintherightmid(50%)andrightbase(80%)• Staging:cT1c• PSAlevel:8
![Page 28: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/28.jpg)
DonaldGleason
![Page 29: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/29.jpg)
GLEASONGRADE
![Page 30: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/30.jpg)
LocalizedProstateCancer:RiskStratification
1. Localizedvs LocallyAdvanced?2. PSAlevel?3. GleasonScore?
![Page 31: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/31.jpg)
%Alive %Deceased
AgeatDiagnosis
YearsFollowingDiagnosisJAMA2005Albertsen,etal
Case:Mr.C
![Page 32: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/32.jpg)
LOWRISK IntermediateRISK HIGHRISK
PSA≤10 PSA10-20 PSA>20
Gleason≤6 Gleason7 Gleason≥8
T2aorsmaller T2b T2c orgreater
LocalizedProstateCancer:RiskStratification
DetermineLifeExpectancyActiveSurveillancevs Treatment
![Page 33: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/33.jpg)
Treatmentoptionsfor“Localized”ProstateCA
1. RadicalProstatectomy
2. XRT• ExternalBeamRT/EBRT• Brachytherapy
3. ActiveSurveillance
![Page 34: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/34.jpg)
Case:Mr.C
PSAlevel
Time2years
![Page 35: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/35.jpg)
• Mr.Creturnstoyourclinic– 7yearsurveillance.
• Wife:“Hehasbeencomplainingofbackpainfor4weeks”
• HisPSAis80
• BoneScansandCTC/A/Pshowevidenceofdiffusemetastaticdiseaseinthespine
• Biopsy:MetastaticProstateCancer
Case:Mr.C
![Page 36: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/36.jpg)
Case:Mr.C
PSAlevel
Time2years 7 years
![Page 37: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/37.jpg)
Whatisyournextstepinmanagement?
1. Lupron2. Lupron+Casodex3. Chemotherapy4. RadiationTherapy5. Zometa
![Page 38: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/38.jpg)
ProstateCancer
• Localizeddisease(orlocallyadvanced)
• MetastaticDisease– StageIV
![Page 39: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/39.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 40: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/40.jpg)
Case:Mr.C
PSAlevel
Time2years 7 years
ADPCAndrogen“Dependent”
ProstateCancer
![Page 41: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/41.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 42: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/42.jpg)
GnRH
![Page 43: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/43.jpg)
Case:Mr.C
PSAlevel
Time2years 7 years
![Page 44: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/44.jpg)
Case:Mr.C
PSAlevel
Time2years 7 years 8 years
![Page 45: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/45.jpg)
Case:Mr.C
PSAlevel
Time2years 7 years 8 years
CastrationResistantProstateCancer
![Page 46: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/46.jpg)
Hypothesis:AndrogenDeprivationTherapy-ADT(“Castration”)
é PSA
AndrogenDeprivation
ADPCAndrogen“Dependent”
ProstateCancer
2-10years
é PSA
êPSA
CRPCCastrationResistantProstateCancer
![Page 47: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/47.jpg)
![Page 48: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/48.jpg)
Hypothesis:AndrogenDeprivationTherapy-ADT(“Castration”)
é PSA
AndrogenDeprivation
ADPCAndrogen“Dependent”
ProstateCancer
2-10years
é PSA
êPSA
CRPCCastrationResistantProstateCancer
![Page 49: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/49.jpg)
HowdoesthetumorsurvivewithlowlevelsofAndrogen?
• Tumor-producedandrogensvia17-20lyase upregulation canpromotesurvival/growthwhen:• IncreasedARexpression1• GeneticalterationsinAR2• IncreasedARcofactorexpressionlevels3
• TotalARindependence• AbsenceofallARproductionandsignalingin25%ofallpost-chemotherapypts 4
CRPCCastrationResistantProstateCancer
1. ChenCD,etal.NatureMed.2004;10:33-39.2. Zaplin ME,etal.JClin Oncol.2003;21:2673-2678.3. Pienta KJ,etal.Clin CancerRes.2006;12:1665-1671.4. Tzelepi VetalClin CancerRes2012;18:666-77
Wow!!!
![Page 50: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/50.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 51: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/51.jpg)
![Page 52: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/52.jpg)
![Page 53: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/53.jpg)
NEJM,2013
Abiraterone priortoChemo
![Page 54: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/54.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 55: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/55.jpg)
![Page 56: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/56.jpg)
NEJM,2014
Enzalutamide priortoChemo
![Page 57: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/57.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 58: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/58.jpg)
ChemotherapyinCRPC
NEJM,2004
![Page 59: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/59.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$
- GnRH Agonist- Leuprolide (Lupron)
$$- GnRH Antagonist
- Degarelix$$$
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex)
$$- Flutamide (Eulexin)
$$
CRPC– “Entrée”:
1- Antiandrogens- Nonsteroidal Antiandrogen
$$- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol$
- CYP17inhibitors$$$
- Abiraterone- ARAntagonists
$$$- Enzalutamide
2.Chemotherapy$$
- Docetaxel- Cabazitaxel
3.Immunotherapy$$$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 60: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/60.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 61: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/61.jpg)
Sipulecel T- (PROVENGE)
![Page 62: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/62.jpg)
Sipulecel T- (PROVENGE)
p=0.03
MedianOSimprovedby4.1months
Cost:$93000
NEJM,2014
![Page 63: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/63.jpg)
ProstateCancer:TreatmentMenu
ADPC– “Appetizer”:
1- SurgicalCastration$
2.MedicalCastration$$$- GnRH Agonist
- Leuprolide(Lupron)- GnRH Antagonist
- Degarelix
- Non-esteroidal Antiandrogen- Bicalutamide (Casodex) $$- Flutamide (Eulexin) $$
CRPC– “Entrée”:
1- Antiandrogens- NonsteroidalAntiandrogen $$
- Bicalutamide (Casodex)- Flutamide (Eulexin)
- Ketoconazol $- CYP17inhibitors $$$
- Abiraterone- ARAntagonists $$$
- Enzalutamide
2.Chemotherapy $$- Docetaxel- Cabazitaxel
3.Immunotherapy $$$$- Sipulecel T
4.Radium223 $$$
SideOrders:
PreventionofSRE:- Biphosphanate Therapy- Denosumab
PalliativeCare
PalliativeRadiation
![Page 64: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/64.jpg)
![Page 65: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/65.jpg)
![Page 66: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/66.jpg)
Radium-223
NEJM,2013
![Page 67: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/67.jpg)
Radium-223
NEJM,2013
![Page 68: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/68.jpg)
Radium-223
![Page 69: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/69.jpg)
Case:Mr.C
PSAlevel
Time2years 7 years 8 years
CRPCADPC
Death
10-15years?
![Page 70: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/70.jpg)
![Page 71: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/71.jpg)
![Page 72: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/72.jpg)
![Page 73: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/73.jpg)
ASCO2014Whynottreatwith
chemotherapyupfront?
PatientswithnewlydiagnosedmetastaticProstateCancer
Docextal vs ADT
![Page 74: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/74.jpg)
NEJM2015
![Page 75: Prostate Cancer€¦ · 11/09/2017 · Which of the following is NOT a risk factor for Prostate Cancer? •Age over 50 •African-American •Father with history of Prostate Cancer](https://reader034.vdocuments.net/reader034/viewer/2022050517/5fa16a74025b5575d212e1c8/html5/thumbnails/75.jpg)
NEJM2015