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The Fellow on Call: The Heme/Onc Podcast
Episode 085: Prostate Cancer Series: Pt. 2. - Pharmacology
Dec 14, 2023
In this podcast, Vineetha Thomas, a clinical pharmacist specializing in genitourinary oncology, discusses the selection of drugs for prostate cancer, their side effects, and the role of chemotherapy. They also explore specific medications like prednisone, sipuleucel-T, radium 223, and lutetium-177. Additionally, they examine the importance of monitoring bone health in prostate cancer patients and the role of clinical pharmacists in prostate cancer treatment.
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Quick takeaways
- The choice between androgen deprivation therapy (ADT) options in prostate cancer treatment often depends on insurance coverage and convenience, with GnRH antagonists being preferred for patients with pre-existing cardiovascular conditions.
- Patients receiving ADT should be counseled on managing side effects such as hot flashes and bone loss, with non-pharmacological strategies and supplementation being important, and pharmacological options like venlafaxine considered for severe symptoms.
Deep dives
Mechanism of Androgen Deprivation Therapy
Androgen deprivation therapy (ADT) is the backbone of prostate cancer treatment, with options including GnRH agonists and antagonists. GnRH agonists act on GnRH receptors in the pituitary gland, initially increasing production of testosterone before downregulating the receptors and lowering testosterone levels. In contrast, GnRH antagonists immediately block the receptors, reducing FSH, LH, and testosterone levels. The choice between agonists and antagonists is often determined by insurance coverage and convenience. For patients with pre-existing cardiovascular conditions, GnRH antagonists may be preferred due to lower rates of major cardiovascular events.
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