CARE OF THE PATIENTS

WITH PROSTATE CANCER

▶ Prostatecancer is cancer that occurs in the prostate — a small

walnut-shaped gland in men that produces the seminal fluid that
nourishes and transports sperm.
▶ Prostate cancer is one of the most common types of cancer in
men. Usually prostate cancer grows slowly and is initially confined
to the prostate gland, where it may not cause serious harm.
However, while some types of prostate cancer
grow slowly and may need minimal or even no
treatment, other types are aggressive and can
spread quickly.

WHAT IS PROSTATE CANCER?

• It's not clear what causes prostate cancer.
• Doctors know that prostate cancer begins when some cells in your prostate
become abnormal. Mutations in the abnormal cells' DNA cause the cells to
grow and divide more rapidly than normal cells do. The abnormal cells
continue living, when other cells would die. The accumulating abnormal cells
 form a tumor that can grow to invade nearby tissue. Some abnormal cells can
also break off and spread (metastasize) to other parts of the body.

PATHOPHYSIOLOGY
 Subjective Cues Objective cues

• Fatigue • Unexplained weight loss due to

• Loss of appetite the caloric needs of the
• Generalized weakness tumor, taking away from the
• Trouble urinating needs of the body.
• Discomfort in the pelvic area • Anorexia.
• Bone pain • Decreased force in the stream of
urine
• Blood in semen
• Erectile dysfunction

ASSESSMENT FINDINGS
▶ Surgical removal of the prostate
(prostatectomy) ▶ retropubic surgery
▶ Lymph node dissection
▶ Radiation therapy.
▶ Radiation therapy to decrease tumor size.
▶ Oxygen therapy to supplement the needs of the body. ▶
High-protein, high-calorie diet to meet the needs of the body.
▶ cryosurgery or cryoablation

SPECIAL NOTATION
▶A radical retropubic prostatectomy is a surgical procedure in
which the prostate gland is removed through an incision in the
abdomen, and the blood vessels that were connected to the
prostate gland are tied off.
RADICAL RETROPUBIC
PROSTATECTOMY
▶ Cryotherapy (also called cryosurgery or cryoablation) is the use of very cold
temperatures to freeze and kill prostate cancer cells as well as most of the prostate. Even
though it is sometimes being called cryosurgery, it is not actually a type of surgery.
CRYOSURGERY
▶ Digital rectal exam
▶ Prostate specific antigen test
▶ Biopsy is confirmative for cancer.
▶ Ultrasonography to further delineate the
mass. ▶ CT scan to check for metastasis
▶ MRI and Positive emission tomography scan

LABORATORY/DIAGNOSTIC EXAMS
HORMONAL THERAPY FOR PROSTATE
CANCER
▶ Even though this is a surgical procedure, it is considered
hormonal therapy because it removes the main source of
testosterone production, the testicles. The effects of this surgery
are permanent and cannot be reversed.
BILATERAL ORCHIECTOMY
▶ LHRH stands for luteinizing hormone-releasing hormone. Medications known as LHRH agonists
prevent the testicles from receiving messages sent by the body to make testosterone. By blocking
these signals, LHRH agonists reduce a man’s testosterone level just as well as removing his testicles.
Unlike orchiectomy, the effects of LHRH agonists are often reversible, so testosterone production
usually begins again once treatment stops. However, testosterone recovery can take from 6
months to 24 months, and for a small number of patients, testosterone production does not return.

▶ LHRH agonists are injected or placed as small implants under the skin. Depending on the drug
used, they may be given once a month or once a year. When LHRH agonists are first given,
testosterone levels briefly increase before falling to very low levels. This effect is known as a “flare.”
Flares occur because the testicles temporarily release more testosterone in response to the way
LHRH agonists work in the body. This flare may increase the activity of prostate cancer cells and
cause symptoms and side effects, such as bone pain if the cancer has spread to the bone.
LHRH AGONISTS
▶ Thisclass of drugs, also called a gonadotropin-releasing hormone (GnRH) antagonist, stops the
testicles from producing testosterone like LHRH agonists, but they reduce testosterone levels
more quickly and do not cause the flare associated with LHRH agonists.
▶ TheFDA has approved degarelix (Firmagon), given by monthly injection, to treat advanced
prostate cancer. One side effect of this drug is that it may cause a severe allergic reaction.
▶ Anoral LHRH antagonist, relugolix (Orgovyx), is also approved by the FDA for the treatment of
advanced prostate cancer.
▶ Relugolix is different from other LHRH antagonists in 2 ways. First, it has a lower risk of causing
serious heart problems in patients with preexisting heart disease. Second, when treatment with
relugolix is stopped, testosterone production is restored within weeks, rather than months, which
may be helpful for those undergoing intermittent hormonal therapy
LHRH ANTAGONISTS
▶ WhileLHRH agonists and antagonists lower testosterone levels in
the blood, androgen receptor (AR) inhibitors block testosterone
from binding to so-called “androgen receptors,” which are
chemical structures in cancer cells that allow testosterone and
other male hormones to enter the cells. In effect, AR inhibitors
stop testosterone from working.

ANDROGEN RECEPTOR INHIBITORS

▶ Apalutamide. Apalutamide is approved by the FDA for the
 treatment of non-metastatic castration-resistant prostate cancer
and for metastatic castration-sensitive prostate cancer in
combination with hormonal therapy.

▶ Darolutamide. Darolutamide is approved for the treatment of non

metastatic
castration-resistant prostate cancer.

▶ Enzalutamide. Enzalutamide is a nonsteroidal AR inhibitor that is

approved to treat metastatic and non-metastatic castration

resistant prostate cancer as well as metastatic castration-sensitive

prostate cancer.

AR INHIBITORS
▶ Although the testicles produce most of the body's testosterone,
other cells in the body can still make small amounts of the
 hormone that may drive cancer growth. These include the
adrenal glands and some prostate cancer cells. Androgen
synthesis inhibitors target an enzyme called CYP17 and stop cells
from making testosterone.

ANDROGEN SYNTHESIS INHIBITORS

▶ Abiraterone acetate (Zytiga). Abiraterone acetate is taken in the
form of a pill. Patients take 4 pills per day along with prednisone
(multiple brand names) or prednisolone (multiple brand names)
twice a day. Prednisone or prednisolone helps prevent some of the
side effects of abiraterone. Abiraterone acetate may cause serious
side effects, such as high blood pressure, low blood potassium levels,
fatigue, and fluid retention. Common side effects include weakness,
joint swelling or pain, swelling in the legs or feet, hot flushes, diarrhea,
vomiting, shortness of breath, and anemia.
▶ Ketoconazole (Nizoral). Ketoconazole is an androgen synthesis
inhibitor that is no longer widely used because of multiple drug
interactions. However, ketoconazole may be an option for some
patients.

EXAMPLES OF ANDROGEN INHIBITORS

▶ Erectile dysfunction

▶ Depression
▶ Loss of sexual desire ▶ Cognitive dysfunction and memory loss

▶ Hot flashes with sweating ▶ Heart problems and heart disease ▶

▶ Gynecomastia, which is growth of Weight gain

breast tissue that sometimes can lead
to discomfort
▶ Loss of muscle mass
 thinning of bones
▶ Osteopenia or osteoporosis, which is

SIDE EFFECTS OF HORMONAL

THERAPY
▶ •cyclophosphamide

▶ •methotrexate

▶ •fluorouracil

▶ •doxorubicin

▶ •epirubincin

▶ •vincristine

▶ •paclitaxel
▶ •docetaxel

CHEMOTHERAPEUTIC DRUGS