The Man with

Prostate Cancer
Margaret Xaira R. Mercado RN

Prostate Cancer
Cancer that forms in tissues of the prostate most common cancer in men second most common cause of cancer deaths in American men older than 55 years of age

Prostate Cancer
2x as high in African American men than in Caucasian men African American men are more likely to die of prostate cancer than men in any other racial or ethnic group.

Risk Factors: Prostate Cancer

increases rapidly after age 50 years 70% of cases occur in men over 65 years of age African American men highest incidence Common in the US and north western Europe Rare in Asia, Africa, Central America, and South America.

Risk Factors: Prostate Cancer

familial predisposition occur in 5% to 10% of diagnosed patients Having a father or brother with prostate cancer doubles the risk A diet high in red meat and fat increases the risk for prostate cancer

Anatomy & Physiology

Located below the bladder and in front of the rectum Stores and secretes a slightly alkaline fluid, milky or white in appearance, usually constitutes 20-30% of the volume of the semen along with spermatozoa and seminal vesicle fluid prostatic fluid is expelled in the first ejaculate fractions, together with most of the spermatozoa contains some smooth muscles that help expel semen during ejaculation

Anatomy & Physiology

Pathophysiology
Precipitating & predisposing factors

Glandular epithelial cells of the prostate gland

Uncontrolled tumor growth Obstruction in the urethra Cancer cells invades urethra & bladder Metastasis to bone, lymph nodes, and other body parts

Difficulty & frequency of urination Urinary retention Decrease in size & force of urine Oliguria

Hematuria Blood in semen Painful ejaculation

Back ache, hip pain, perineal & rectal discomfort, anemia, weight loss, weakness

Normal Anatomy & Comparison

Clinical Manifestations
Urinary obstruction -difficulty & frequency of urination
-urinary retention -decreased size & force of the urinary stream

Blood in urine or semen Painful ejaculation Symptoms related to metastasis:

backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria

Assessment & Diagnostic Findings

Prostate if stony hard & fixed advanced lesion

DRE 40 years above

-provides clinical information about the rectum, anal sphincter, & stool quality

Histologic examination of tissue -transrectal needle biopsy (Fine needle aspiration)

Assessment & Diagnostic Findings

DIGITAL RECTAL EXAM
doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas

PROSTATE-SPECIFIC ANTIGEN (PSA) test:

measures the level of PSA in the blood. Increased amount in the blood of men who have prostate cancer, infection or inflammation of the prostate, or BPH

Assessment & Diagnostic Findings

TRANSRECTAL ULTRASOUND A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes.

Assessment & Diagnostic Findings

TRANSRECTAL NEEDLE BIOPSY
The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide the needle

Assessment & Diagnostic Findings

BONE SCANS detects metastatic bone
disease

SKELETAL X-RAYS identifies bone

metastases

EXCRETORY UROGRAPHY detects

changes caused by ureteral obstruction

RENAL FUNCTION TESTS CT SCAN or LYMPHANGIOGRANGRAPHY

identifies metastases in pelvic or lymph nodes

Assessment & Diagnostic Findings

SEXUAL COMPLICATIONS
Common experience of men with prostate cancer nerve-sparing radical prostatectomy chance of recovering erections is better hormonal therapy affects CNS mechanism that mediates sexual dysfunction SILDENAFIL erectile dysfunction

Staging

Medical Management
RADIATION THERAPY
Teletherapy or Brachytherapy

SURGICAL MANAGEMENT HORMONAL THERAPY

-method used to control rather than cure prostate cancer -suppresses androgenic stimuli to the prostate by decreasing the circulating plasma testosterone levels or interrupting the conversion

OTHER TREATMENT MODALITIES

Radiation Therapy
TELETHERAPY
6-7 weeks of daily radiation treatment

BRACHYTHERAPY
80-100 seeds implanted under anesthesia HEALTH TEACHINGS: 1. Strain urine 2. Use condom during intercourse

Surgical Management
TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)
Special scope that looks like a thin tube with a light on the end is put into the hole at the tip of your penis where urine comes out. The bladder will then be filled with a solution so that the doctor will see the inside of body better. A small surgical tool will be inserted through the scope which is used to remove a part of the enlarged prostate. A catheter (tube) will be left in the bladder to allow for urine flow after the procedure. It may also be used to flush the bladder and to remove blood clots

Surgical Management
OPEN PROSTATECTOMY Surgery to remove an enlarged prostate that's causing urinary symptoms. The doctor will remove the entire prostate through a cut (incision) beneath the navel

Surgical Management
RADICAL PROSTATECTOMY - if done in early stage of prostate cancer, potentially curable with 10 years life expectancy SIDE EFFECTS: sexual impotence 5% - 10% urinary incontinence

Surgical Management
SUPRAPUBIC PROSTATECTOMY

Surgical Management
PERENIAL PROSTATECTOMY

Other Treatment Modality

CRYOSURGERY

Nursing Management
Pain related to progression of disease and treatment modalities
1. Evaluate nature of patients pain, its location and intensity using pain rating scale. 2. Avoid activities that aggravate or worsen pain. 4. Provide support for affecte extremities. 5. Prepare patient for radiation therapy if prescribed. 6. Administer analgesics or opioids at regularly scheduled intervals as prescribed.

Nursing Management
Imbalanced nutrition: less than body requirements related to decreased oral intake because of anorexia, nausea, and vomiting caused by cancer or its treatment
1. Assess the amount of food eaten. 2. Routinely weigh patient. 3. Elicit patients explanation of why he is unable to eat more. 4. Cater to his individual food preferences 5. Recognize effect of medication or radiation therapy on appetite.

Nursing Management
Sexual dysfunction related to effects of therapy: chemotherapy, hormonal therapy, radiation therapy, surgery
1. Determine from nursing history what effect patients medical condition is having on his sexual functioning. 2. Inform patient of the effects of prostate surgery, orchiectomy (when applicable), chemotherapy, irradiation, and hormonal therapy on sexual function. 3. Include his partner in developing understanding and in discovering alternative, satisfying close relations with each other.

Nursing Management
Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan, and prognosis
1. Obtain health history to determine the following: a. Patients concerns b. His level of understanding of his health problem c. His past experience with cancer d. Whether he knows his diagnosis of malignancy and its prognosis e. His support systems and coping methods

Nursing Management
Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan, and prognosis
2. Provide education about diagnosis and treatment plan: a. Explain in simple terms what diagnostic tests to expect, how long they will take, and what will be experienced during each test. b. Review treatment plan and allow patient to ask questions.

Nursing Management
Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan, and prognosis
3. Assess his psychological reaction to his diagnosis/prognosis and how he has coped with past stresses. 4. Provide information about institutional and community resources for coping with prostate cancer: social services, support groups, community agencies

Discharge Instructions
ACTIVITY - Healing period 4-8 weeks
No strenuous activities & heavy lifting Do not drive for 2 weeks except for short rides Take long walks but take stairs slowly & carefully Continue exercises to avoid blood clots May take shower but avoid bath tubs

Discharge Instructions
BLEEDING Can occur anytime after surgery
Common after BM, coughing, or increased exercise (+) hematuria increase OFI & rest until the urine is clear If heavy bleeding plugs the channel inform care provider immediately Avoid ASA & NSAIDs for @ least 2 weeks

Discharge Instructions
BOWEL MOVEMENTS
Keep bowel movements regular and soft Drink fruit juices Take mild laxatives as ordered

DIET
Normal diet may be resumed Increase OFI up to 10 glasses/day Avoid alcohol otherwise advised by the physician

Discharge Instructions
SEXUAL INTERCOURSE
<Abstain from sexual intercourse 6 weeks post surgery <Erections may be present while the catheter is in place <When sex is resumed, ejaculate may flow back into the bladder expect a little or no semen at all

Discharge Instructions
URINATION
bBurning, stinging, or leakage for several weeks may be felt after removal of catheter bDisappears as the area heals pads may be needed to control leakage

WORK
May resume work within 4 weeks if not strenuous Otherwise 6 to 8 weeks

Discharge Instructions
PLEASE NOTIFY YOUR DOCTOR IF: 1. Unable to urinate 2. Bleeding is excessive & not controlled by fluids and rest 3. Have chills, fever or severe abdominal pain 4. Scrotum becomes swollen or tender 5. Pain is present on one calf, chest pain or difficulty of breathing

 the beginning of knowledge is in the discovery of something we dont understand