Cebu Normal University College of Nursing

Osmea Blvd. Cebu City

PROSTATE CANCER
Submitted To: Mr. Jerald S. Ugdoracion, RN

Submitted By: Caballo, Jake T. Cornel, Krizia Marie M. Gonzales, Kimberly Glezet S. Quieta, Justine Emm E. Vergara, Burt Joshua T. Wong, Mary Cyrielle A. Group 3, BSN IV-B PROSTATE CANCER

Prostate Cancer defined:

Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. Generally, the tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs (abnormalities on physical examination). However, all prostate cancers do not behave similarly. Some aggressive types of prostate cancer grow and spread more rapidly than others and can cause a significant shortening of life expectancy in men affected by them. A measure of prostate cancer aggressiveness is the Gleason score (discussed in more detail later in this article), which is calculated by a trained pathologist observing prostate biopsy specimens under the microscope. As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.

A cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.
A tumor in the prostate interferes with proper control of the bladder and normal sexual functioning. Often the first symptom of prostate cancer is difficulty in urinating. However, because a very common, non-cancerous condition of the prostate, benign prostatic hyperplasia (BPH), also causes the same problem, difficulty in urination is not necessarily due to cancer.

Etiologic Factors:
It is estimated that 1 in ever 6 males will develop prostate cancer in their lifetime. There are known risk factors for prostate development and more research is being conducted. Just being a man puts males at risk. The cause of prostate cancer is unknown, but hormonal, genetic, environmental, and dietary factors are thought to play roles. The following risk factors have been linked with development of this condition:

Prostate Cancer Risk Factors All men are at risk for developing prostate cancer. About one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 34 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer. Besides being male, there are other factors, such as age, race, and family history that may contribute to the risk. These include:

Age. The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after the age of 40 in black men and men who have a close relative with prostate cancer. About two-thirds of all prostate cancers are diagnosed in men age 65 and older.

Family history. Men whose relatives have had prostate cancer are considered to be at high risk. Having a father or brother with the disease more than doubles your risk for prostate cancer, according to the American Cancer Society. Having a brother with prostate cancer appears to increase your risk more than having an affected father does. That risk is even higher when there are multiple family members affected. Screening for prostate cancer should be started at age 40 in these men. Studies have identified several inherited genes that appear to increase prostate cancer risk. Testing for these genes is not yet available. Experts estimate that the hereditary form of prostate cancer accounts for just 5-10% of all cases.

Race. Prostate cancer occurs about 60% more often in African American men than in white American men and when diagnosed is more likely to be advanced. However, Japanese and African males living in their native countries have a low incidence of prostate cancer. Rates for these groups increase sharply when they immigrate to the U.S. African Americans are the second group of men for whomprostate cancer testing should begin at age 40. Some experts theorize that this suggests an environmental connection, possibly related to high-fat diets, less exposure to the sun, exposure to heavy metals such as cadmium, infectious agents, or smoking. To date, the reasons for these racial differences are not understood.

Diet.

Research also suggests high dietary fat may be a contributing factor prostate cancer. The disease is much more common in countries where meat and dairy products are dietary staples, compared to countries where the basic diet consists of rice, soybean products, and vegetables. Eating a diet high in the antioxidant lycopene (found in high levels in some fruits and vegetables, such as tomatoes, pink grapefruit, and watermelon) may lower your risk of developing prostate cancer according to several studies.

Medication Exposure There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk. Viral In 2006, researchers associated a previously unknown retrovirus, Xenotropic MuLV-related virus or XMRV, with human prostate tumors. Subsequent reports on the virus have been contradictory. A group of US researchers found XMRV protein expression in human prostate tumors, while German scientists failed to find XMRV-specific antibodies or XMRV-specific nucleic acid sequences in prostate cancer samples.

Infection Recent evidence has suggested the role of sexually transmitted infections as one of the causative factors for prostate cancer. People who have had sexually transmitted infections are reported as having 1.4 times greater chance of developing the disease as compared to the general population.

Manifestations:
In the early stages, prostate cancer often causes no symptoms for many years. As a matter of fact, these cancers frequently are first detected by an abnormality on a blood test (the PSA, discussed below) or as a hard nodule (lump) in the prostate gland. Occasionally, the doctor may first feel a hard nodule during a routine digital (done with the finger) rectal examination. The prostate gland is located immediately in front of the rectum.

Rarely, in more advanced cases, the cancer may enlarge and press on the urethra. As a result, the flow of urine diminishes and urination becomes more difficult. Patients may also experience burning with urination or blood in the urine. As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder. These symptoms by themselves, however, do not confirm the presence of prostate cancer. Most of these symptoms can occur in men with non-cancerous (benign) enlargement of the prostate (the most common form of prostate enlargement). However, the occurrence of these symptoms should prompt an evaluation by the doctor to rule out cancer and provide appropriate treatment. Furthermore, in the later stages, prostate cancer can spread locally into the surrounding tissue or the nearby lymph nodes, called the pelvic nodes. The cancer then can spread even farther (metastasize) to other areas of the body. Symptoms of metastatic disease include fatigue, malaise, and weight loss. The doctor during a rectal examination can sometimes detect local spread into the surrounding tissues. That is, the physician can feel a hard, fixed (not moveable) tumor extending from and beyond the gland. Prostate cancer usually metastasizes first to the lower spine or the pelvic bones (the bones connecting the lower spine to the hips), thereby causing back or pelvic pain. The cancer can then spread to the liver and lungs. Metastases (areas to which the cancer has spread) to the liver can cause pain in the abdomen and jaundice (yellow color of the skin) in rare instances. Metastases to the lungs can cause chest pain and coughing. Prostate cancer symptoms do not usually appear until the disease has advanced, and many times has already been diagnosed. However, there are symptoms you should watch aware of, especially signs and symptoms related to urination. Urinary Symptoms of Prostate Cancer The urethra is a small to exit the body. In men, the shaped gland responsible for the prostate enlarges and difficulties with urination. tube that runs from the bladder, allowing urine urethra is surrounded by the prostate, a walnut producing semen. As prostate cancer advances, constricts the urethra. The result is various

Urinary difficulties can be common prostate cancer symptoms, but can also indicate other non-malignant prostate problems, like BPH. Prostate cancer symptoms related to urination include:

burning or pain during urination inability to urinate frequent nocturnal urination weak urine stream

blood in urine (either seen by the eye or microscopically, although less common)

Other Symptoms of Prostate Cancer Urinary difficulties in men over 40 usually raises red flags for doctors to check the prostate gland for abnormalities. However, prostate cancer can cause some other vague symptoms. Non-specific symptoms that may accompany urinary symptoms include:

pelvic pain back or hip pain weight loss

Exams and Tests

A proper medical interview and physical examination are essential in the diagnostic workup of any man in whom prostate cancer is suspected. You may be referred to a physician who specializes in urinary tract diseases (a urologist) or in urinary tract cancers (a urologic oncologist). You will be asked questions about your medical and surgical history, your lifestyle and habits, and any medications you take.

Blood tests
These are used to detect complications of prostate cancer. Complete blood cell count: The hemoglobin level and relative amounts of different blood cells are checked. Anemia is a common sequel to cancers, as are certain other blood irregularities. Hepatic transaminases: These are enzymes produced in the liver. They are called alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In known prostate cancer, these levels are usually elevated when the cancer has spread to the liver. However, levels of these enzymes can be abnormally high in a number of different conditions that have nothing to do with cancer.

Alkaline phosphatase: This enzyme is found in the liver and in bone. It is a sensitive indicator of both liver and bone cancer. BUN and creatinine: These measures are used to assess how well the kidneys are working. Levels can be elevated in a number of conditions and may suggest an obstruction. Prostatic specific antigen (PSA): This is an enzyme produced by both normal and abnormal prostate tissues. It may be elevated in noncancerous conditions, such as prostatitis (inflammation of the prostate) and benign prostatic hypertrophy (noncancerous enlargement of the prostate), as well as in cancer of the prostate. PSA values may be more helpful over time in following recurrence of cancer and the response to treatment than in diagnosing a previously unknown cancer. The following standards have been set for PSA levels: Less than 4 ng/mL: Normal value

4-10 ng/mL: Either benign disorder or cancer Greater than 10 ng/mL: Most likely cancer Less than 0.2 ng/mL: After prostate is surgically removed

Traditionally, a PSA of 4 ng/ml has been used as a cutoff value for deciding for or against doing a prostate biopsy. However, some experts now recommend lowering that to 2.5 ng/ml and performing the biopsy in men who have levels in excess of this threshold. The American Urological Association guidelines (2009) do not define a definite cutoff point but advise that all the other risk factors for prostate cancer be taken into account while making a decision on whether to proceed for a biopsy. One of the important factors that need to be considered is the rate at which the PSA value has increased over time on repeated measurements (PSA velocity).

Imaging studies
These reveal the size and location of the tumor in the prostate as well as the extent of spread of the disease. CT scan or MRI of abdomen and pelvis This is the best way to detect the extent of the primary cancer as well as distant metastases.

Chest x-ray film This is a simple test that shows whether cancer has spread to the lungs. Ultrasound of kidneys, bladder, and prostate Ultrasonography can be used to look for the effects of a urinary blockage on the kidneys. This is indicated by signs of swelling within the kidney (hydronephrosis). This study can also be used to assess the bladder for any sign of urinary obstruction due to prostate enlargement by looking at the thickness of the bladder wall and the amount of urine left inside the bladder after passing urine. Cystoscopy This is an endoscopic test which is usually performed in selected situations. A thin, flexible, lighted tube with a tiny camera on the end is inserted through the urethra to the bladder. The camera transmits images to a video monitor. This may show whether the cancer has spread to the urethra or bladder Technetium Tc 99m bone scan This test is like an X-ray film of the entire body taken after a mildly radioactive substance is administered into a vein. The radioactive substance highlights areas where the cancer has affected the bones. This test is usually reserved for men with prostate cancer who have deep bone pain or a fracture or who have biopsy findings and high PSA values (>10-20 ng/ml) suggestive of advanced or aggressive disease.

Biopsy When the findings of the physical exam, lab tests, and imaging studies suggest that a cancer is present in the prostate, the diagnosis must be confirmed by taking a sample of the tumor (biopsy). The tumor tissue is examined by a doctor who specializes in diagnosing diseases by looking at cells and tissues (a pathologist). Gleasons score: Another very important assessment that the pathologist makes from the specimen is the grade (Gleason's score) of the tumor. This indicates how different the cancer cells are from normal prostate tissue. Grade gives an indication of how fast a cancer is likely to grow and has very important implications on the treatment plan and the chances of cure after treatment. A

Gleason score of 6 generally indicates low grade (less aggressive) disease while that of 8-10 suggests high grade (more aggressive) cancer. A grade of 7 is regarded as somewhere in between these two. Staging If the biopsy finding is positive for cancer, further staging procedures will be done. Staging is a system of classifying tumors by size, location, and extent of spread, local and remote. Staging is an important part of treatment planning because tumors respond best to different treatments at different stages. Stage is also a good indicator of prognosis, or the chances of success after treatment. Staging is usually accomplished through imaging studies and lab tests. Prostate cancers are also assigned a grade, which indicates how different the cancer cells are from normal prostate tissue. Grade gives an indication of how fast a cancer is likely to grow. The stages of prostate cancer are as follows: Stage I (or A): The cancer cannot be felt on digital rectal exam, and there is no evidence that it has spread outside the prostate. These are often found incidentally during surgery for an enlarged prostate. Stage II (or B): The tumor is larger than a stage I and can be felt on digital rectal exam. There is no evidence that the cancer has spread outside the prostate. These are usually found on biopsy when a man has an elevated PSA level. Stage III (or C): The cancer has invaded other tissues neighboring the prostate. Stage IV (or D): The cancer has spread to lymph nodes or to other organs. Most doctors currently use the 2002 TNM (Tumor, Node, Metastases) staging system for prostate cancer. This is based on a combination of three criteria: the extent of the primary tumor (T stage), involvement of lymph nodes by the cancer (N stage), and the presence or absence of spread to distant areas of the body in the form of metastasis (M stage). The TNM 2002 staging system is as follows: Evaluation of the (primary) tumor ("T") TX: cannot evaluate the primary tumor T0: no evidence of tumor

T1: tumor present but not detectable clinically or with imaging T1a: The tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons). T1b: The tumor was incidentally found in greater than 5% of prostate tissue resected. T1c: The tumor was found in a needle biopsy performed due to an elevated serum PSA. T2: The tumor can be felt (palpated) on examination but has not spread outside the prostate T2a: The tumor is in half or less than half of one of the prostate gland's two lobes. T2b: The tumor is in more than half of one lobe but not both. T2c: The tumor is in both lobes. T3: The tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2). T3a: The tumor has spread through the capsule on one or both sides. T3b: The tumor has invaded one or both seminal vesicles. T4: The tumor has invaded other nearby structures. It should be stressed that the designation "T2c" implies a tumor which is palpable in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but which are not palpable bilaterally should not be staged as T2c. Evaluation of the regional lymph nodes ("N") NX: The regional lymph nodes cannot be evaluated. N0: There has been no spread to the regional lymph nodes N1: There has been spread to the regional lymph nodes. Evaluation of distant metastasis ("M") MX: A distant metastasis cannot be evaluated. M0: There is no distant metastasis M1: There is distant metastasis. M1a: The cancer has spread to lymph nodes beyond the regional ones. M1b: The cancer has spread to bone. M1c: The cancer has spread to other sites (regardless of bone involvement).

Complications:

Cancer that spreads. Prostate cancer can spread to nearby organs or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to other areas of the body is more difficult to treat than cancer that is confined to the prostate. Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery. Erectile dysfunction. Erectile dysfunction can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction. Unfortunately, for many men who have undergone treatment for prostate cancer, complications of their treatment is a fact of life. Erectile Dysfunction Erectile dysfunction (ED) is probably the best known complication following treatment. Men who have undergone surgery, radiation, or hormonal therapies for their cancer face fairly high rates of ED afterward. Depending on the type of procedure and other underlying medical problems that the man may have, 50% may experience ED following treatment. Many drugs such as sildenafil (better known asViagra) have shown good results in men who have undergone treatment, while other options such as penile implants are available for treating ED as well. Incontinence Incontinence, or the inability to control ones bowel or bladder function, is also fairly common following standard prostate cancer treatments. Prostate cancer itself can also result in this condition if untreated. Incontinence may be temporary or permanent as well as treatable or untreatable. By changing their behavior (such as scheduling times to urinate each day), many men are able to deal with their incontinence in relatively simple ways. Similarly, many men practice special exercises that strengthen the lower pelvic muscles in order to provide better control over bladder function. Pain Pain can be present before, during, or after treatment has been completed. Most men have some pain in the days following surgery, but this usually dissipates. Other men may have

significant pain associated with their prostate cancer and, once it is treated, their pain is greatly decreased or even eliminated. Pain varies greatly from individual to individual, but a large variety of effective treatments exist for pain of all types. Depression One of the more commons complications of prostate cancer and its treatment is depression. For many men, prostate cancer is their first brush with their own mortality and this can be a cause for great concern and sadness regardless of how well their treatment works. The aforementioned complications (ED, incontinence, and pain) can cause significant mental strain as well. While not as commonly addressed by the patients family or medical caregivers as other complications, depression is still a significant obstacle for many men. This is especially true in the short-term after diagnosis and treatment. Again, a variety of options are available for getting through depression that may occur with prostate cancer. These may include the use of counseling or medication alternatives.

Collaborative Management:
Prostate Cancer Treatment Treatments for prostate cancer are effective in most men. They cause both short- and long-term side effects that may be difficult to accept. You and your life partner or family members should discuss your treatment options in detail with your urologist and other physicians. Make sure you understand which treatments are available, how effective each is likely to be, and what side effects can be expected. You must weigh all these choices carefully before making a decision about which course to pursue. Several treatments are available for prostate cancer. The choice of treatment depends on age, general medical condition, and the extent of the tumor spread. Your treatment plan should be individualized for you, depending on your feelings about the different treatments and their potential side effects. One treatment option is known as watchful waiting. This involves monitoring the cancer to see if it gets worse and how quickly. Often prostate cancers grow very slowly, and many men do well without treatment for some time. For older men with other serious medical problems, the risks involved with treatment such as surgery may outweigh the potential benefits.

Watchful waiting is a conservative regimen that includes regular visits to your urologist for digital rectal exams, PSA measurements, and, if necessary, imaging tests and/or repeated prostate biopsies to assess if the cancer is becoming more aggressive over time. One benefit to watchful waiting is that you do not experience the side effects of treatment. On the other hand, your symptoms (if any) will continue. In some cases, symptoms can be at least partly relieved with medication. Surgery For stage I and stage II prostate cancer, surgery is the most common method of treatment because it theoretically offers the chance of completely removing the cancer from the body. Radical prostatectomy involves complete removal of the prostate. The surgery can be done using a perineal approach, where the incision is made between the scrotum and the anus, or using a retropubic approach, where the incision is made in the lower abdomen. Perineal approach is also known as nerve-sparing prostatectomy, as it is thought to reduce the effect on the nerves and thus reduce the side effects of impotence and incontinence. However, the retropubic approach allows for the simultaneous removal of the pelvic lymph nodes, which can give important pathological information about the tumor spread. A second method of surgical treatment of prostate cancer is cryosurgery, or cryotherapy. Guided by ultrasound, surgeons insert up to eight cryoprobes through the skin and into close proximity with the tumor. Liquid nitrogen (temperature of -320.8 degrees F, or -196 C) is circulated through the probe, freezing the tumor tissue. In prostate surgery, a warming tube is also used to keep the urethra from freezing. Patients currently spend a day or two in the hospital following the surgery, but it could be an outpatient procedure in the near future. Recovery time is about one week. Side effects have been reduced in recent years, although impotence still affects almost all who have had cryosurgery for prostate cancer. Cryo-surgery is considered a good alternative for those too old or sick to have traditional surgery or radiation treatments or when these more traditional treatments are unsuccessful. There is limited amount of information about the long-term efficacy of this treatment for prostate cancer. Radical prostatectomy Radical prostatectomy is surgical removal of the entire prostate. This operation is indicated for cancer that is limited to the prostate and has not

invaded the capsule of the prostate, any other nearby structures or lymph nodes, or distant organs. The entire prostate, seminal vesicles, and ampulla of the vas deferens are removed, and the bladder is connected to the membranous urethra to allow free urination. Complications of this procedure include urinary incontinence and impotence. Newer techniques spare the nerve that controls urination and erection. Of men who undergo these newer techniques, 98% are continent, and 60% are able to have an erection. Radical prostatectomy can be combined with radiation therapy in men with cancer that is even further isolated in the prostate area. There is an excellent survival rate if cancer has not spread. Radical prostatectomy can be performed by open surgery, laparoscopic surgery, or by robotic surgery (robotic assisted radical prostatectomy). Currently, almost 70% of radical prostatectomy surgeries in the U.S. are performed with the help of the Da Vinci robotic system. For robot-assisted surgery, five small incisions are made in the abdomen through which the surgeon inserts tube-like instruments, including a small camera. This creates a magnified three-dimensional view of the surgical area. The instruments are attached to a mechanical device, and the surgeon sits at a console and guides the instruments through a viewing device to perform the surgery. The instrument tips can be moved in a variety of ways under the control of the surgeon to achieve greater precision in surgery. So far, studies show that traditional open prostatectomy and robotic prostatectomy have had similar outcomes related to cancer-free survival rates, urinary continence, and sexual function. However, in terms of blood loss during surgery and pain and recovery after the procedure, robotic surgery has been shown to have a significant advantage. There are various different types of prostate surgery that can be performed including:

Radical retropubic prostatectomy. The entire gland, and nearby lymph nodes, is removed through an incision in the abdomen. Radical perineal prostatectomy. The entire gland is removed through an incision between the scrotum and the anus. Nearby lymph nodes can also be removed at the same time through a separate incision in the abdomen. Laparoscopic prostatectomy. The entire gland, and nearby lymph nodes, is removed through a number of small incisions, rather than a single long cut in the abdomen. A thin, lighted tube known as a laparoscope is used to remove the prostate. Transurethral resection of the prostate (TURP). Part of the gland is removed using a long, thin device which is inserted through the urethra. TURP may not remove all of the cancer, but it can remove tissue that is blocking the flow of urine.

Pelvic lymphadenectomy. This procedure is routinely carried out during prostate surgery. Lymph nodes in the pelvis are removed to see if cancer has spread to them, indicating that the disease may have spread to other parts of the body.

Radiation Therapy Radiation therapy involves the use of high-energy x rays to kill cancer cells or to shrink tumors. It can be used instead of surgery for stage I and II cancer. The radiation can either be administered from a machine outside the body (external beam radiation), or small radioactive pellets can be implanted in the prostate gland in the area surrounding the tumor, called brachytherapy or interstitial implantation. Pellets containing radioactive iodine (I-125), palladium (Pd 103), or iridium (Ir 192) can be implanted on an outpatient basis, where they remain permanently. The radioactive effect of the seeds last only about a year. The side effects of radiation can include inflammation of the bladder, rectum, and small intestine as well as disorders of blood clotting (coagulopathies). Impotence and incontinence are often delayed side effects of the treatment. A study indicated that bowel control problems were more likely after radiation therapy when compared to surgery, but impotence and incontinence were more likely after surgical treatment. Long-term results with radiation therapy are dependent on stage. A review of almost 1,000 patients treated with megavoltage irradiation showed 10-year survival rates to be significantly different by T-stage: T1 (79%), T2 (66%), T3 (55%), and T4 (22%). There does not appear to be a large difference in survival between external beam or interstitial treatments. Hormone Therapy Hormone therapy is commonly used when the cancer is in an advanced stage and has spread to other parts of the body, such as stage III or stage IV. Prostate cells need the male hormone testosterone to grow. Decreasing the levels of this hormone or inhibiting its activity will cause the cancer to shrink. Hormone levels can be decreased in several ways. Orchiectomy is a surgical procedure that involves complete removal of the testicles, leading to a decrease in the levels of testosterone. Another method tricks the body by administering the female hormone estrogen. When estrogen is given, the body senses the presence of a sex hormone and stops making the male hormone testosterone. However, there are some unpleasant side effects to hormone therapy. Men may have "hot flashes," enlargement and tenderness of the breasts, or impotence and loss of sexual desire, as well as blood clots, heart attacks, and strokes, depending on the dose of estrogen.

Another side effect is osteoporosis, or loss of bone mass leading to brittle and easily fractured bones. Watchful Waiting In certain men, a strategy of withholding active treatment may be used. While treatment is withheld, the patient is monitored closely for signs of change in their disease or the development of new symptoms. If it is determined at any time that the cancer is progressing, active treatment may then be started. This kind of wait and see approach is chosen most often in men who are older and who have other significant medical problems. Other Therapy Cryotherapy: This technique involves inserting a probe through a small skin incision and freezing areas of cancer in the prostate. This therapy is reserved for cancer localized within the prostate as well as for men who are unable to withstand the conventional therapies such as surgery or radiation The probe is guided to areas of cancer by using TRUS. Cancerous tissue appears on the ultrasound and allows the surgeon to monitor therapy and limit damage to normal prostate tissue.There are several advantages to using this procedure over surgery and radiation therapy. There is less blood loss, shorter hospital stay, shorter recovery times, and less pain than with conventional surgery.The long-term effectiveness of this procedure is unknown because it is a newer treatment. HIFU (high intensity focused ultrasound) was first developed as a treatment of benign prostatic hyperplasia (BPH) and now is also being used as a procedure for the killing of prostate cancer cells. This procedure utilizes transrectal ultrasound that is highly focused into a small area, creating intense heat of 80 C-100 C, which is lethal to prostate cancer tissue. The published clinical experience with HIFU for this application is limited and the procedure is not yet approved by the FDA for use in the United States.

Nursing Management:
Provide encourage the patient to express his fears and concerns, including those about changes in his sexual identity, owing to surgery. Offer reassurance when possible. Give analgesics as necessary Administer ordered. Provide comfort measures to reduce pain. Encourage the patient to identify care measures that promote his comfort and relaxation. Monitor voiding patterns, watch for bladder distention and assist with catheterization if indicated.

 Provide instruction before surgery Prepare the patient; antiembolism stockings are applied before surgery to prevent deep vein thrombosis (DVT) if patient is placed in lithotomy position during surgery Enema is administered on the morning of surgery to prevent postoperative straining, which can induce bleeding After prostatectomy Regularly check the dressing, incision, and drainage systems for excessive blood. Also watch for signs of bleeding (pallor, restlessness, decreasing blood pressure, and increasing pulse rate). Be alert for signs of infection (fever, chills, inflamed incisional area). Maintain adequate fluid intake (at least 2,000 ml daily). Give antispasmodics, as ordered, to control postoperative bladder spasms. Also provide analgesics as needed. Because urinary incontinence commonly follows prostatectomy, keep the patients skin clean and dry. Monitor and manage potential complications ( Hemorrhage, Infection, Deep Vein Thrombosis, Obstructed Catheter, Urinary Incontinence and Sexual Dysfunction) Encourage the patient to prevent incontinence by increasing voiding frequency, avoiding positions that encourage the urge to void, and decreasing fluid prior to activities. Teach patient on Pelvic floor exercises. Assess for sexual dysfunction after surgery. Provide a private and confidential environment to discuss issues of sexuality. Teach patients self care After suprapubic prostatectomy Keep the skin around the suprapubic drain dry and free from drainage and urine leakage. Encourage the patient to begin perineal exercises between 24 and 48 hours after surgery. Allow the patients family to assist in his care and encourage them to provide psychological support. Give meticulous catheter care. After prostatectomy, a patient usually has a three-way catheter with a continuous irrigation system. Check the tubing for kinks, mucus plugs, and clots, especially if the patient complains of pain. Warn the patient not to pull on the tubes or the catheter.

After transurethral resection

Watch for signs of urethral stricture (dysuria, decreased force and caliber of urine stream, and straining to urinate). Also observe for abdominal distention (a result of urethral stricture or catheter blockage by a blood clot). Irrigate the catheter, as ordered.

After perineal prostatectomy Avoid taking the patients temperature rectally or inserting enema or other rectal tubes. Provide pads to absorb draining urine. Assist the patient with frequent sitz baths to relieve pain and inflammation.

After perineal or retropubic prostatectomy Give reassurance that urine leakage after catheter removal is normal and subsides in time.

After radiation therapy Watch for the common adverse effects of radiation to the prostate. These include proctitis, diarrhea, bladder spasms, and urinary frequency. Internal radiation of the prostate almost always results in cystitis in the first 2 to 3 weeks of therapy. Encourage the patient to drink at least 2,000 ml of fluid daily. Administer analgesics and antispasmodics to increase comfort.

After hormonal therapy When a patient receives hormonal therapy with diethylstilbestrol, watch for adverse effects (gynecomastia, fluid retention, nausea, and vomiting). Be alert for thrombophlebitis (pain, tenderness, swelling, warmth, and redness in calf).

Patient teaching and home health guide Nursing Care Plans Prostate Cancer Before surgery, discuss the expected results. Explain that radical surgery always produces impotence. Up to 7% of patients experience urinary incontinence. To help minimize incontinence, teach the patient how to do perineal exercises while he sits or stands. To develop his perineal muscles, tell him to squeeze his buttocks together and hold this position for a few seconds; then relax. He should repeat this exercise as frequently as ordered by the physician.

Prepare the patient for postoperative procedures, such as dressing changes and intubation. If appropriate, discuss the adverse effects of radiation therapy. All patients who receive pelvic radiation therapy will develop such symptoms as diarrhea, urinary frequency, nocturia, bladder spasms, rectal irritation, and tenesmus. Encourage the patient to maintain a lifestyle thats as nearly normal as possible during recovery. When appropriate, refer the patient to the social service department, local home health care agencies, hospices, and other support organizations.

Prevention Because the cause of prostate cancer is uncertain, preventing prostate cancer may not be possible. Certain risk factors, such as age, race, sex, and family history, cannot be changed. However, because diet has been implicated as a potential cause, living a healthy lifestyle may afford some protection. Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer.Eating certain foods that contain substances called antioxidants (vitamins C and E and beta carotene) may be protective. Some research suggests that taking vitamin E, an antioxidant, may reduce the risk of not only prostate cancer but also other cancers. This theory remains unproven. Certain medications like finasteride (Propecia, Proscar) and dutasteride (Avodart) have been shown in some recent studies to be effective in decreasing the risk of developing prostate cancer. A discussion with your urologist with regard to these medications should be considered especially, if you have a higher risk of acquiring the disease based on your family history.

Internet Sources:

http://prostatecancer.about.com/od/treatment/a/treatment.htm http://prostateproblemcenter.com/prostate-surgery.html http://www.webmd.com/prostate-cancer/guide/prostate-cancer-surgery http://familydoctor.org/online/famdocen/home/common/cancer/treatme nt/264.html

http://prostatecancer.about.com/od/aftertreatmenthasended/a/complic ations.htm http://www.mayoclinic.com/health/prostatecancer/DS00043/DSECTION=complications http://cancer.about.com/od/prostatecancer/a/prostatesymptom.htm http://www.webmd.com/prostate-cancer/guide/prostate-cancer-riskfactors http://info.cancerresearchuk.org/cancerstats/types/prostate/riskfactors/ http://www.myhealthtoday.com/top-risk-factors-prostate-cancer/ http://www.mayoclinic.com/health/prostatecancer/DS00043/DSECTION=risk-factors http://www.emedicinehealth.com/prostate_cancer/article_em.htm