Back pain from metastatic prostate cancer - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 07-18-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 584 Times in 354 Posts
Reputation: 594
Question Back pain from metastatic prostate cancer

A 68-year-old man presents with back pain from metastatic prostate cancer. The MRI shows large spinal lesions
that are near the cord but not compressing it. What is the best initial therapy?

a. Flutamide
b. Gonadotropin-releasing hormone (GnRH) agonists (leuprolide, goserelin)
c. Ketoconazole
d. Orchiectomy
e. Steroids

Please Give Explanation
Reply With Quote Quick reply to this message



  #2  
Old 07-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 760 Times in 256 Posts
Reputation: 771
Default

e. Steroids
Reply With Quote Quick reply to this message
  #3  
Old 07-18-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Ans .e........ appears to be steroids as rest all drugs dec androgens and shrink prostrate ca .... so steriods may prevent spinal cord edema and compression .....
Reply With Quote Quick reply to this message
  #4  
Old 07-18-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 584 Times in 354 Posts
Reputation: 594
Default

steroids are indicated when tumor compresses cord. here it is not compressing.
Quote:
MRI shows large spinal lesions
that are near the cord but not
compressing it
Reply With Quote Quick reply to this message
  #5  
Old 07-18-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Quote:
Originally Posted by tyagee View Post
steroids are indicated when tumor compresses cord. here it is not compressing.

Great do an Orchiectomy ..he is 68 ... No longer needs them .......

as all drugs help in treatment ..... so may be flutamide as it is an antagonist will shrink metastasis .... so A ...i guesss....
Reply With Quote Quick reply to this message
  #6  
Old 07-18-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 584 Times in 354 Posts
Reputation: 594
Default

Quote:
Originally Posted by Hitman View Post
Great do an Orchiectomy ..he is 68 ... No longer needs them .......

as all drugs help in treatment ..... so may be flutamide as it is an antagonist will shrink metastasis .... so A ...i guesss....
he may not like orchiectomy afterall !!!

ans given was flutamide, leuprolide is sort of CI because it is GnRH agonist and will bump the size of metz in starting.

but is it okay saying NO to steroids just because tumor is lying next to but not compressing...
Reply With Quote Quick reply to this message
The above post was thanked by:
drzamzam (09-08-2015)
  #7  
Old 07-18-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 151
Threads: 48
Thanked 109 Times in 60 Posts
Reputation: 119
Default

ANS is Flutamide....
The best therapy for metastic lesions (note the plural) to the spinal cord from the prostate is actually GnRH...but the initial flare-up from the GnRH can lead to a growth of the mets and actually cause a CORD compression!!!....

Hence its advisable to initially block the DHT receptors with FLutamide or bicalutamide before commencing therapy with GnRH.....

as long as there is no neurological signs...steroids may not be the initial therapy...except in OBVIOUS case of trauma...where there is no other differential to worry about!!!
Reply With Quote Quick reply to this message
The above post was thanked by:
jakir (09-15-2015), K06100 (07-18-2012), Novobiocin (07-18-2012)
  #8  
Old 07-19-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 584 Times in 354 Posts
Reputation: 594
Default

Quote:
Originally Posted by stfidel View Post
as long as there is no neurological signs...steroids may not be the initial therapy...except in OBVIOUS case of trauma...where there is no other differential to worry about!!!
what do you mean by this ?

**as per my know, steroids were found to do harm than benefit in head trauma...dont know for vertebral column though. ya, steroids+cord compression= steroids. thats okay.
Reply With Quote Quick reply to this message
  #9  
Old 07-19-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 151
Threads: 48
Thanked 109 Times in 60 Posts
Reputation: 119
Default

@tygaee...we are talking about spinal cord!! not head trauma
Reply With Quote Quick reply to this message



Reply

Tags
Oncology-, Rheumatology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
The histology of ostoeblastic metastatic prostate tumor? meka USMLE Step 1 Forum 11 12-29-2014 08:55 PM
Most common metastatic cancer to liver? tyagee USMLE Step 1 Forum 4 07-19-2012 07:49 PM
Breast Cancer then Lower Back Pain? tyagee USMLE Step 2 CK Forum 41 04-26-2012 05:34 PM
Management of metastatic lung cancer Dr.NickRiviera USMLE Step 1 Forum 6 03-27-2012 05:53 PM
Breast cancer history and now comes with back pain docoftheworld USMLE Step 2 CK Forum 2 06-09-2011 04:57 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)