Quiz: AUA castration-resistant PCa guideline amendment

In 2018, the AUA amended its treatment guideline for castration-resistant prostate cancer (CRPC) “to reflect new literature released related to the treatment of patients with non-metastatic castration-resistant prostate cancer,” according to the association. The following six questions are meant to test your knowledge of these updates to the guideline.

Question 1

Continued androgen deprivation plus ________ should be offered to men with non-metastatic, high-risk CRPC.

A. Apalutamide (Erleada) or enzalutamide (XTANDI)

B. Enzalutamide or abiraterone (ZYTIGA)

C. Apalutamide or abiraterone

D. None of the above

Continue to the next page for the answer.Answer

A. Apalutamide or enzalutamide

In patients with non-metastatic CRPC at high risk for developing metastatic disease, clinicians should offer apalutamide or enzalutamide with continued androgen deprivation, based on strong evidence.

Question 2

Which of the following should be offered to patients with symptomatic or minimally symptomatic metastatic CRPC with good performance status and no prior docetaxel (Taxotere) therapy?

A. Abiraterone plus prednisone

B. Enzalutamide

C. Docetaxel

D. Any of the above

Continue to the next page for the answer.

Answer

D. Any of the above

According to the guideline: “Clinicians should offer abiraterone plus prednisone, enzalutamide or docetaxel to patients with symptomatic, mCRPC with good performance status and no prior docetaxel chemotherapy. (Standard; Evidence Level Grade A [abiraterone plus prednisone and enzalutamide] / B [docetaxel])."

Question 3

Which of the following should be offered to patients with mCRPC and good performance status and prior docetaxel?

A. Abiraterone plus prednisone

B. Enzalutamide

C. Cabazitaxel (Jevtana)

D. Any of the above

Continue to the next page for the answer.

Answer

D. Any of the above

From the guideline: “Clinicians should offer treatment with abiraterone plus prednisone, cabazitaxel or enzalutamide to patients with mCRPC with good performance status who received prior docetaxel chemotherapy. If the patient received abiraterone plus prednisone prior to docetaxel chemotherapy, they should be offered cabazitaxel or enzalutamide. (Standard; Evidence Level Grade A [abiraterone] / B [cabazitaxel] / A [enzalutamide])”

Question 4

Patients with bony mCRPC and good performance status who have received prior docetaxel therapy and have no known visceral disease should be offered:

A. External beam radiation therapy

B. Surgery

C. Radium-223 (Xofigo)

D. Docetaxel

Continue to the next page for the answer.Answer

C. Radium-223

Radium-223 should be offered to such patients with good performance status.

Question 5

Oral ketoconazole toxicities can include:

A. Liver toxicity

B. Adrenal insufficiency

C. Dangerous drug interactions

D. All of the above

Continue to the next page for the answer.

Answer

D. All of the above

Ketoconazole oral tablet side effects include hepatotoxicity, adrenal insufficiency, and dangerous drug interactions, according to an FDA safety announcement.

Question 6

Systemic chemotherapy or immunotherapy should not be offered for non-metastatic CRPC outside the context of clinical trials.

A. True

B. False

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Answer

A. True

Non-metastatic CRPC should not be treated with immunotherapy or chemotherapy except in clinical trials due to significant toxicity concerns.