Benign Prostatic Hyperplasia

and
Cancer of Prostate

Presented by
Stephen James
Objectives
 Define Benign Prostatic Hyperplasia (BPH) and Cancer
of the Prostate( Ca Prostate)
 Describe the etiology, pathophysiology and
complications of BPH and Ca Prostate
 Identify common diagnostic test use in the evaluation
of BPH and Ca Prostate.
 Discuss the relevant medical and surgical treatment
for BPH and Ca Prostate
 Discuss the pre and post op care for a client
undergoing prostatic surgery
 Discuss discharge planning for client with BPH and Ca
prostate.
Anatomy and Physiology
overview
 Located between the pubic bone
posteriorly and the rectum anteriorly.
 It lies inferiorly to the bladder
 It envelopes (surrounds) the upper
portion of the urethra
 It’s the size of a wall nut
 It is covered by muscle tissue
(ejaculation)
 Consist of small glands that produces
90% of seminal fluid
Definition
 BPH: is enlargement of the prostate
cause by proliferation of glandular
and stromal cells

 Ca Prostate: carcinoma of the

prostate
Incidence
 20% of men 40 yrs

 70% by age 60

 90% by the eighth decade of life

ETIOLOGY
BPH
 Unknown

 Increase androgen levels

(testosterone)

 Ageing (increase estrogen levels)

Clinical manifestations
Obstructive symptoms
 Hesitancy
 Urgency
 Frequency
 nocturia
 Hematuria
 retention
Clinical manifestations cont’d
 Decrease in volume and force of
stream
 Dribbling
 Interruption of the urinary stream
 Retrograde ejaculation
Renal symptoms
 uremia
Clinical manifestations
 Painful ejaculation
 Bone pain (metastases to bone)
 Anaemia
 Weight loss
 Perineal and rectal discomfort
 Hard nodule in the prostate
Pathophysiology
 Compression of the urethra
 Retention of urine (distention and
hypertrophy of bladder)
 Infection of urine
 Hydronephrosis
 Uremia
 NB nodular hyperplasia is not a
premalignant legion.
Enlarge Prostate
Staging
Staging
Complications
Prostatic complications
 Acute retention
 Chronic retention
 Hemorrhage
Bladder complications
 Diverticula
 Urinary infection
 Stone formation
Complications cont’d
Renal complications
 Hydronephrosis

 uremia
PROSTATE GLAND
Diagnostic evaluation
 History and physical examination

 serum urea and creatinine

 Prostatic Specific Antigen

 Acid Phosphatase (ACP)

 Urine cultures (MSU,CSU)

Diagnostic Evaluation cont’d
 Ultra sound

 Intravenous pyelogram (IVP)

 Digital examination

 Prostatic biopsy

 Bone scan
Transrectal Prostate Biopsy
Medical Management for BPH
Pharmacological
 5 alpha- reductase inhibitors
(finasteride)

 Alpha adrenergic blocker (Hytrin,

flomax)
Medical Management for Ca
Prostate
 Hormonal (stilboestrol)

 Radiation

 Chemotherapy

 Cryosurgery
Surgical
 Cryosurgery

 Transurethral resection of the prostate

 Suprapubic Prostatectomy

 Perineal Prostatectomy

 Retropubic Prostatectomy
Transurethral approach
Suprapubic approach
Suprapubic, Perineal sites
NG CARE The Patient With
Prostate Cancer
 Brunner and Suddarth's Textbook of
Med.-Surg. Nursing 12th ed. (2 vols)
- S. Smeltzer, et al., (Lippincott,
2010) BBS
 PAGE 1518
SCENARIO
 Mr. James a 58 year old married man is brought to
the emergency room by his son. He is extremely
uncomfortable and has been unable to void urine for
the last 18 hours. He has known for some time that
he has an enlarge prostate due to malignancy but has
wanted to ovoid surgery due to its effects on sexual
function. He is schedule to have a radical
prostatectomy. Using the nursing process outline the
care to be given to MR James in the first 48 hrs post
operatively.
Discharge Planning
Mr. James is discharge after four days in
hospital, you are the nurse
responsible for his discharge
planning, discuss the relevant nursing
interventions you would include in his
plan.
THE END