PSA (PROSTATE SPECIFIC ADVANCEMENTS): …



PSA (PROSTATE SPECIFIC ADVANCEMENTS): UNDERSTANDING SUPPORTIVE CARE, UPDATED GUIDELINES, AND NOVEL MEDICATIONSPharmacist Post-testPharmacist Learning ObjectivesDESCRIBE current diagnostic methods and classifications for prostate cancerLIST new treatment options for prostate cancer and their monitoring parametersRECALL supportive care interventions for patients experiencing troubling symptoms APPLY the principles of motivational interviewing to patients who have prostate cancer to improve medication adherence 1. What is the first step in evaluating an abnormal prostate specific antigen (PSA) level? A. Perform a biopsy B. Perform a digital rectal exam (DRE)C. Repeat the PSA level2. Which of the following additional PSA tests can be beneficial in determining prostate cancer treatment?A. circulating PSA (cPSA)B. PSA doubling timeC. free PSA (fPSA)3. Which group of prostate cancer patients are categorized into risk groups (very low to very high)? A. Localized prostate cancerB. Regional prostate cancerC. Metastatic prostate cancer4. Which of the following drugs has evidence supporting its use in very high risk patients as adjuvant treatment in addition to radiation therapy and androgen deprivation therapy?A. ApalutamideB. DocetaxelC. Olaparib5. Which of the following new treatment options has been shown to be effective in both non-metastatic castrate-resistant and castrate-sensitive prostate cancers?A. DarolutamideB. EnzalutamideC. Olaparib6. How often should thyroid stimulating hormone (TSH) be monitored during apalutamide therapy?A. Baseline and every four monthsB. Baseline and if symptoms occurC. Baseline and monthly7. Which of the following treatments for prostate cancer requires confirmation of BRCA-mutation before using?A. DarolutamideB. Docetaxel C. Olaparib8. Which of the following second-generation antiandrogens should be taken with food?A. ApalutamideB. DarolutamideC. Enzalutamide9. Which of the following is the first-line management of a rash with apalutamide?A. Permanently discontinue apalutamideB. Continue therapy and use oral antihistamines and topical corticosteroidsC. Interrupt therapy and use oral corticosteroids10. Which of the following is appropriate for all men receiving androgen deprivation therapy?A. Calcium 1000 mg/day + vitamin D3 400 international units/day to prevent bone lossB. Venlafaxine 25 mg po daily to prevent hot flashes C. Oral sildenafil 25 mg po daily to prevent erectile dysfunction11. Which of the following statements is TRUE regarding bone health in prostate cancer?A. Prevention of skeletal-related events with a bone-modifying agent is recommended for all men with metastatic prostate cancerB. Bone modifying agents are recommended in men with prostate cancer receiving ADT with osteopenia and > 3% 10-yr probability of a fractureC. Bone loss typically does not occur until a patient has received 12 months of androgen deprivation therapy12. A 69-year-old man with castrate-resistant metastatic prostate cancer receiving leuprolide therapy 22.5 mg intramuscularly every 12 weeks and abiraterone 1000 mg po daily + prednisone 5 mg po daily has bone metastases. His 10-year probability of facture based on the Fracture Risk Assessment Tool (FRAX) risk is 2.4%.?Which of the following is the most appropriate to add to his prostate cancer regimen for bone health?A. Alendronate 70 mg po weekly + calcium/vitamin DB. Denosumab 120 mcg SQ q 4 weeks + calcium/vitamin DC. Calcium 500 mg po daily and vitamin D3 400 international units po daily only13. A 73-year-old man with a history of local prostate cancer previously treated with prostatectomy and androgen deprivation therapy for two years experienced a PSA recurrence in January 2019. At the time, he was restarted on leuprolide 22.5 mg intramuscularly (IM) q 12 weeks and had a good PSA response. In April 2020, his PSA started to rise despite testosterone levels <50 ng/dL, and he has no evidence of metastatic disease. He has been diagnosed with nonmetastatic castrate-resistant prostate cancer with a PSA doubling time of 8 months. His PMH is significant for multiple fractures due to osteopenia and hypothyroidism, and hypertension, which has been difficult to control.?His physician is recommending darolutamide, but he seems reluctant to fill the prescription and start this new drug. Which of the following is the BEST WAY to start a conversation using motivational interviewing?A. “I hear you saying that you don’t want to fill this prescription. That would be a mistake.”B. “What are your concerns, and how can I help you deal with those concerns?”C. “Do you think you might change your mind any time soon?”14. A 71-year-old man with BRCA1-mutated castrate-resistant metastatic prostate cancer recently progressed while receiving enzalutamide. He started olaparib recently and has experienced considerable nausea. Which of the following questions represents the reflective listening step of motivational interviewing?A. “I understand what you are saying about how the nausea makes you unable to do anything except sit and watch TV.”B. “Would you mind if I share some self-management techniques with you, and then you can tell me what you think?”C. “Have you tried exercising regularly, and avoiding caffeine, alcohol, and hot/spicy food?”15. A 61-year-old male is diagnosed with very high risk localized prostate cancer. He is going to receive external beam radiation therapy and leuprolide 22.5 mg IM q 12 weeks. Docetaxel 75 mg/m2/dose IV over 1 hour every 21 days + prednisone 10 mg po daily x 6 cycles is added. Premedication: dexamethasone 8 mg po BID x 3 days, beginning the day before docetaxel. He says that his doctor told him to omit the prednisone on days he is receiving dexamethasone, but he plans to take it anyway. You listen to his ideas, clarify his thought process, and reflect back that he thinks that he needs the prednisone to “keep the cancer at bay.” What do you say next? A. “You already discussed this with your oncologist and the oncologist’s support nurse, didn’t you?” B. “Would you mind if I share some thoughts with you, and then you can tell me what you think?”C. “You don’t actually expect me to agree with this ridiculous plan, do you? Just follow the doctor’s orders!” ................
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