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PROSTATE CANCER CASE STUDY

Prostate Cancer Case Study

Vivian A. Ocampo

NURS 530 APRN Advanced Physiology and Pathophysiology

West Coast University

Dr. Alana Wood

March 24, 2021

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Introduction

The diagnosis of cancer has not only become one of the leading causes of death in the

United States, but as well as one of the most feared diagnoses. Prostate cancer is the most

commonly diagnosed male malignancy in the world and the fourth leading cause of death in men

(Leslie, Soon-Sutton, & Sajjad, 2020). Unlike most types of cancers, prostate cancers grow

slowly and demonstrate minimal aggressiveness. Differentiation of prostate cancers varies

worldwide, “there is greater incidence in western countries, partly due to lifestyle and

environmental factors” (Tian, Guo, & Zheng, 2018). As with all cancers in general, early

detection and intervention are key in management as well as in optimizing patient outcomes.

Identification of symptoms and proper diagnostic findings must be integrated to differentiate

between other diagnoses. In conjunction with this, early diagnosis and interventions significantly

decrease the mortality rate of individuals diagnosed with prostate cancer.

Pathophysiology

The prostate gland is located at the base of the penis, inferior to the urinary bladder. This

type of cancer, known as an adenocarcinoma, initiates with mutation of prostate glandular cells,

beginning with peripheral basal cells (Leslie, Soon-Sutton, & Sajjad, 2020). Due to the primary

development of cancer in the glandular part of the organ and exhibition of glandular patterns by

microscopic examination, this type of cancer is categorized as an adenocarcinoma. The tumor

nodule is formed as the cancer cells grow and multiply throughout the prostate tissue, with

common metastasis to the bones and lymph nodes (Leslie, Soon-Sutton, & Sajjad, 2020).

Genetics

The risk of prostate cancer increases with familial history of the cancer. According to the

National Comprehensive Cancer Network, “Approximately 11% of patients with prostate cancer
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and at least 1 additional, primary cancer carry germline mutations associated with increased

cancer risk” (Journal of the National Comprehensive Cancer Network, 2019). Due to the increase

in frequency of germline DNA repair gene mutations in patients with prostate cancer, assessment

of genetic counseling and risk for second cancers is strongly recommended.

Diagnostic Testing and Rationales

Like all cancers, early detections and accurate staging is crucial in determining survival

rate and appropriate interventions. Integrative cancer research has determined the lack of

universally approved imaging methods for the early detections of prostate cancer due to the

tissue heterogeneity present in this type of cancer (Tian, Guo, & Zheng, 2018). One of the

antigens used for screening of this cancer is the prostate-specific membrane antigen (PSMA).

This antigen is considered an exceptional target for molecular imaging because it is

overexpressed in 90-100% of prostate cancer lesions. In conjunction with this, PSMA-targeted

imaging is one of the most common and effective methods used to screen prostate cancer cells

under in vitro and in vivo models, offering image-guided therapy and precise monitoring of

disease progression (Tian, Guo, & Zheng, 2018). Because imaging studies are not yet accepted

as adjuncts to staging, other common diagnostics include digital rectal exams, biopsy specimens,

and prostate-specific antigen blood test. The purpose of digital rectal examinations is to detect

asymmetry, prostate abnormalities, and nodules. About 20% of all prostate cancers are detected

by abnormal digital rectal examinations, and approximately 80% of patients diagnosed with

prostate cancers present with an elevated serum PSA, the protein produced by the prostate

(Leslie, Soon-Sutton, & Sajjad, 2020). The use of PSA screening has dropped the mortality rate

related to prostate cancer significantly and continues to be used for early detection and treatment.

Treatment
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PROSTATE CANCER CASE STUDY
Treatment of prostate cancers depends on the staging of the cancer itself. Often times,

early detection can lead to over treatment of prostate cancers that are not threatening life

expectancy. This results in substantial increase of health care expenditures and an impairment in

quality of life. Optimal treatment of prostate cancers also involves risk assessment of progress to

metastasis after treatment as well as risk for metastasis. Nomograms can be used to predict

outcomes for and individual patient and can be used for those considering radical prostatectomy,

brachytherapy, external beam RT, and active surveillance. The use of nomogram allows for the

calculation of potential success with a certain treatment of choice. Androgen deprivation therapy

(ADT) is considered the gold standard for patient with metastatic disease, hormonal therapy

decreases the number of androgens available in the body, therefore inhibiting cancer growth

(Journal of the National Comprehensive Cancer Network, 2019).

How does the information in this case inform the practice of a master’s prepared nurse?

Knowledge is power. Nurses encounter patients with a variety of comorbidities and

diseases. It is crucial for all heath care professionals to have a basis of common diagnoses so that

proper education may be given to patients. The master’s prepared nurse is able to apply research

into evidence-based practice to promote optimal patient care.

How should the master’s prepared nurse use this information to design a patient education

session condition?

In the information presented in the case study above, early detection and accurate

interventions are strongly promoted. Educating patients on the importance of digital rectal

examinations as well as recommended history and physicals aid in promoting early detection of

prostate cancers. Strong patient education enables compliance and adherence with care plans and

health promotion.
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PROSTATE CANCER CASE STUDY

What was the most important information presented in this case?

The most important information presented in this case is diagnosis and treatment. Often

times patients undergo a variety of testing and diagnostics when first diagnosed with a disease

process. Afterwards, the question of treatment is the most important to them. Common questions

include, “How will I be treated?” or “How long do I have to live?”. By providing patients

education on treatment modalities, patients can choose treatments that will allow them to have an

optimal quality of life and increase in survival rate.

What was the most confusing or challenging information presented in this case?

The most challenging information presented in this case was the diagnosis process and

pathophysiology. Understanding how cancer occurs and the impact of genetic factors in the

development of prostate cancer can be difficult to understand.

Discuss a patient safety issue that can be addressed for a patient with the condition

presented in this case.

A patient safety issue that can be addressed is the possible delay in early detection as well

as delay in treatment due to possible denial of diagnosis. For many patients, a diagnosis of cancer

leads them to believe death is imminent. Because of this, patients may be hesitant to receive

treatment. Patient education on survival rates with specific treatments can be promoted with the

use of nomograms.

Conclusion

Prostate cancer continues to be on of the most commonly diagnosed cancers in men and

contribute to a significant number of cancer-related deaths worldwide. Early detection and

treatment is one of the most important factors when diagnosing prostate cancer. Patient education
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should be provided to those with an increase in risk of development. By encouraging frequent

and recommended visits for prostate cancer screening, the mortality rate for this abundant type of

cancer will continue to decrease.

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References

Journal of the National Comprehensive Cancer Network. (2019, May). NCCN Clinical Practice

Guidelines in Oncology. Retrieved March 2021, from Journal of the National

Comprehensive Cancer Network: https://jnccn.org/view/journals/jnccn/17/5/article-

p479.xml

Leslie, S. W., Soon-Sutton, T. L., & Sajjad, H. (2020, January). Prostate Cancer. Retrieved

March 2021, from National Center for Biotechnology Information:

https://www.ncbi.nlm.nih.gov/books/NBK470550/

Merriel, S. W., Funston, G., & Hamilton, W. (2018, August 10). Prostate Cancer in Primary

Care. Retrieved from National Institutes of Health:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133140/

Tian, J.-Y., Guo, F.-J., & Zheng, G.-Y. (2018, March). Prostate cancer: updates on current

strategies for screening, diagnosis and clinical implications of treatment modalities.

Retrieved March 2021, from Oxford Academic:

https://academic.oup.com/carcin/article/39/3/307/4690592?login=true