92.3 🩺 內科專科考前版

92.3.0.1 📌 䞀頁重點

  • 22E:
    • PSMA PET-CT revolutionizing staging + recurrence
    • ¹⁷⁷Lu-PSMA-617 (Pluvicto, FDA 2022) theranostic for mCRPC
    • PARP combos: PROpel (olaparib + abiraterone), TALAPRO-2 (talazoparib + enzalutamide), MAGNITUDE (niraparib + abiraterone)
    • Triple therapy mHSPC: PEACE-1 (ADT + docetaxel + abiraterone)
    • Relugolix oral GnRH antagonist (FDA 2020)
  • Taiwan: 健保 LHRH agonist (leuprolide, goserelin) + antiandrogen (bicalutamide); 健保 abiraterone + enzalutamide + apalutamide + darolutamide (條件); 健保 docetaxel + cabazitaxel; 健保 zoledronic + denosumab; 健保 olaparib (條件); Pluvicto + relugolix + niraparib combo 自費 倚 / 條件 limited

92.3.0.2 🌟 Pearls (10)

  1. PSMA PET sensitivity > conventional imaging at low PSA (~ 0.5 ng/mL biochemical recurrence)
  2. PSMA PET å…š staging prostate CA standard now (CT + bone scan inferior)
  3. HRR mutations ~ 25% mCRPC; BRCA1/2 ~ 10%
  4. Germline testing indicated for high-risk localized + metastatic prostate CA
  5. Triple therapy PEACE-1: ADT + docetaxel + abiraterone for high-volume mHSPC; OS benefit
  6. Pluvicto eligibility: PSMA-PET positive; previous ARSi + chemo
  7. Theranostic paradigm: imaging (PSMA PET) → targeted therapy (Pluvicto)
  8. Radium-223 + ARSi combo discontinued (ERA-223 — 增 fracture)
  9. CRPC after surgery + RT: salvage options + early systemic
  10. Bone health in ADT: DXA + bisphosphonate / denosumab; FRAX

92.3.0.3 📍 Taiwan + 健保

  • 健保 LHRH agonist (leuprolide, goserelin)
  • 健保 LHRH antagonist (degarelix)
  • Relugolix (Orgovyx) 自費 倚 (新, oral)
  • 健保 bicalutamide
  • 健保 abiraterone + prednisone 條件
  • 健保 enzalutamide / apalutamide / darolutamide 條件
  • 健保 docetaxel + cabazitaxel
  • 健保 olaparib 條件 (BRCA+ in metastatic)
  • Niraparib / talazoparib combos 自費 倚
  • 健保 zoledronic + denosumab
  • 健保 PSMA PET 條件 (限制䞭心)
  • ¹⁷⁷Lu-PSMA-617 (Pluvicto) 自費 倚 / 限制
  • 健保 radical prostatectomy + EBRT + brachytherapy

92.3.0.4 🎓 內專必懂 (10)

  1. PSA workup + biomarkers + MRI + targeted biopsy
  2. PSMA PET (22E gold standard)
  3. Gleason ISUP grade groups
  4. Risk stratification + active surveillance
  5. Localized treatment options
  6. mHSPC ADT + intensification (CHAARTED, STAMPEDE, LATITUDE, PEACE-1)
  7. mCRPC sequential novel AR + chemo + PARP + Pluvicto
  8. HRR / BRCA + PARP combos (PROpel, TALAPRO-2, MAGNITUDE)
  9. Pluvicto theranostic paradigm
  10. ADT side effects + monitoring (bone, CV, metabolic)

⚠ AI 草皿。