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Old man's burden? - aisman
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06-08-2010, 09:50 AM
A 70-yr old man is diagnosed with prostate cancer after developing severe back pain not relieved by rest about a month ago. MRI shows metastasis to the lumbosacral spine as well as cord-compression. What is the next best treatment?
A. Leuprolide B. Flutamide + leuprolide C. Flutamide D. Orchiectomy E. Ketoconazole F. Finasteride
06-08-2010, 10:08 AM
why d??
i think we have to give dexamethasone first to releivecord compression , though no option
06-08-2010, 10:17 AM
C-Flutamide Per MTB: 1.) localized prostate cancer: surgery and either external radiation or implanted radioactive pellets are equally efficient. 2.)Metastatic: Androgen blockage is the standard of care: Flutamide (androgen antag), Leuprolide or goserelin( GNRH agonist) Flutamide should be started first to block the flare up of the androgens accompanying the GNRH agonists. Ketoconazole , at high dose, can block androgens , but it is not as effective as other therapies.
06-08-2010, 10:21 AM
I agree with NBME456.
When the cord compression present, first steroids and then Flutamide
06-08-2010, 10:44 AM
Thanx guys.
YES..Give steroids 1st to relieve compression. However, what this question tests is what anti-androgen treatment is given in this situation. I'm a little confused myself 2 be honest. MTB says ans is C: flutamide first to block initial flare up associated with leuprolide..(verbatim quote from advil2011 above)... Uworld says ans is A: Leuprolide for metastatic disease. Flutamide is considered inferior to LHRH analogs, though some studies show benefits combining the 2...... Any other thoughts?
06-08-2010, 10:54 AM
Aiaman frm where did u get this question?
Bcoz there was a question in Kaplan q BANK,,,,,where they had given the same c/f and asked what is the best and the fastest way to relieve his symptoms. The answer there was Orchiec tomy and it was written tht it is the most definative and fastest way to relieve his symptoms Fr ketoconazole t was written that it has a slow onset of action and it takes 8 hrs to act. I don remember whether Flutamide ,Leuprolide was there in choice or not in Kaplan Q bank
06-08-2010, 11:03 AM
gainer84,
mtb says orchiectomy is fastest way 2 lower androgen/testosterone level...but not routinely done.
06-08-2010, 11:03 AM
ll u guys will be correct , but questiuon is not written as should be , next step of treatmnet
should always be to releive cord compression , would u allow u patient to be paralyzed , and continue treating prostaic cancer |
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