92.2 📚 國考版醫垫國考 / PGY OSCE

92.2.0.1 📌 Cram Sheet

92.2.0.1.1 🔥 高 yield 12
  1. Adenocarcinoma 95%
  2. PSA 4 ng/mL + modifiers + biomarkers
  3. MRI + PI-RADS + targeted biopsy (PRECISION)
  4. Gleason ISUP GG 1-5
  5. PSMA PET (22E) for staging + recurrence
  6. Active surveillance for low-risk (GG 1, PSA < 10, T1-T2a)
  7. Localized: prostatectomy / EBRT + ADT (high-risk)
  8. mHSPC triple: ADT + chemo + abiraterone (PEACE-1)
  9. mCRPC: novel AR (enzalutamide, apalutamide, darolutamide), abiraterone, docetaxel
  10. HRR / BRCA: olaparib + abiraterone (PROpel)
  11. ¹⁷⁷Lu-PSMA-617 (Pluvicto) for PSMA+ mCRPC (FDA 2022, 22E)
  12. Radium-223: bone-only mets
92.2.0.1.2 🔢 必背
項目 æ•žå­—
PSA cutoff 4 ng/mL
Free PSA % concerning < 25%
PSMA PET gold for recurrence
Active surveillance criteria GG 1, PSA < 10, T1-T2a
ADT castration cutoff T < 50
ADT in localized high-risk 2-3 yr
ADT in intermediate 4-6 mo (some 12-18)

92.2.0.2 ⭐ 高 yield

92.2.0.2.1 Drug Quick mCRPC
Drug Mechanism
Abiraterone CYP17 (+ prednisone)
Enzalutamide AR antagonist (2nd gen)
Apalutamide AR antagonist
Darolutamide AR antagonist (less CNS)
Docetaxel Chemo (taxane)
Cabazitaxel Chemo (post-doc)
Sipuleucel-T Immune therapy
Radium-223 Alpha-emitter (bone)
Olaparib PARP (BRCA/HRR)
Niraparib + abiraterone PARP combo
Talazoparib + enzalutamide PARP combo
¹⁷⁷Lu-PSMA-617 PSMA radioligand
92.2.0.2.2 Trials
  • CHAARTED: ADT + docetaxel mHSPC
  • STAMPEDE: multi-arm
  • LATITUDE: ADT + abiraterone mHSPC
  • ENZAMET: ADT + enzalutamide mHSPC
  • TITAN: ADT + apalutamide mHSPC
  • PEACE-1: triple (ADT + docetaxel + abiraterone)
  • PROpel: olaparib + abiraterone HRR
  • VISION: ¹⁷⁷Lu-PSMA-617 mCRPC
  • ALSYMPCA: radium-223 bone mets
92.2.0.2.3 Adverse Effects ADT
  • Hot flashes
  • Loss of libido + ED
  • Osteoporosis + fracture
  • Sarcopenia
  • Cognitive
  • CV risk
  • Gynecomastia
  • Anemia
  • Manage: lifestyle, exercise, bone monitoring + bisphos/denosumab, CV optimize

92.2.0.3 🎯 自我檢枬

  1. PSA cutoff? → 4 ng/mL
  2. Gleason → GG? → 1-5 (ISUP)
  3. Active surveillance criteria? → GG 1, PSA < 10, T1-T2a
  4. mHSPC triple? → ADT + chemo + abiraterone
  5. mCRPC novel AR 3? → Enzalutamide, apalutamide, darolutamide
  6. PROpel? → Olaparib + abiraterone (HRR)
  7. Pluvicto target? → PSMA
  8. Radium-223? → Alpha-emitter bone-only
  9. Sipuleucel-T? → Immune therapy modest benefit
  10. ADT castration T? → < 50
  11. Bone-modifying agent? → Zoledronic / denosumab
  12. PSMA PET role? → Staging + biochemical recurrence
  13. Targeted biopsy trial? → PRECISION
  14. Family Hx BRCA in mCRPC? → Test for HRR mutation
  15. Initial flare LHRH agonist protection? → Antiandrogen for 1-4 wk before/with

⚠ AI 草皿。