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Prostate Cancer 2


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Prostate Cancer: Risk Factors
1) African Americans
2) Age > 65 y/o
Testosterone Production?
Testes: 95%
Adrenal Glands: 3% – 5%
Orchiectomy Advantages:
Rapidly reduces circulating androgens to castrate levels < 50 ng/dL

Prolongs survival
Tumor Flare?
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
Tumor Flare Blocked by:
LHRH Agonists: Side Effects
Decr. Libido
Hot Flashes
Bone Loss (Osteoporosis)
LHRH Agonists: Dosage
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
Antiandrogens: Drugs
Biclutamide (Casodex)
Antiandrogens: Drug Dosages
Flutamide 250mg po tid

Biclutamide(Casodex)50mg po qd

Nilutamide 300mg po qd x1month then 150 mg po qd
Antiandrogens: Treatment of choice
⬢ 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
Antiandrogens: Hormone withdrawal
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.
Antiandrogen Side Effects
Impotence / Decreased libido
Hot flashes
LFT abnormailities
GI Pain
Dirrhea (Flutamide)
Chemotherapy in Prostate
Mitoxantrone + Prednisone with decr. pain score but no impact on survival

Estramustine + Docetaxel
Medical Adrenalectomy
Ketoconazole 400 mg po q8h
Estrogen therapy
CV events (MI)

Current Strategy for Hormonal Therapy:
Orchiectomy and monitor PSA for dropping. Other tx if rising

LHRH+Antiandrogen FRONTLINE (efficacy 80-90% with relapse in 2 yrs)
Risks for Tumor Flair
Is tumor in spinal cord or close to blocking off kidney's with risk of blocking kidney's

NO then LHRH alone OK
Herbal Therapy:
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)

Deck Info