PROSTAT

E
CANCER
 OVERVIEW
Prostate cancer is cancer that occurs in the prostate. The prostate is a small
walnut-shaped gland in males that produces the seminal fluid that nourishes and
transports sperm. Prostate cancer is one of the most common types of cancer.
Many prostate cancers grow slowly and are confined to the prostate gland, where
they 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.  Prostate cancer can be slow-growing, such
that many men die of other diseases before the prostate cancer causes significant
problems. However, many prostate cancers are more aggressive and can spread
outside the confines of the prostate gland, which can be deadly. The prostate
cancer survival rate is greatly improved with early detection and personalized
treatment.
 Table of Contents

01. 02. 03.

Prevention &
Pathophysiology Signs & Symptoms Screening

04. 05.
Treatment & Prognosis Nursing Management
PATHOPHYSIOLOG
Y
…….
 PROSTATE CANCER
RISK FACTORS :
• AGE - Prostate cancer occurs in who are above 40 of age and rare in younger
men. The chances getting prostate cancer rise rapidly after the age of 50.
• RACE - Most often it occurs in African-American men and in Caribbean men of
African ancestry than in men of other races. Mostly black men carry risk of prostate
cancer than do men of other races.
• FAMILY HISTORY - Prostate Cancer may run in families due to the inherited
genetic factors. Having a father or brother with prostate cancer more than doubles a
man’s risk of developing this disease.
• GENETIC FACTORS - Some of the genetic factors such as the mutation in the
portion of the gene called BRCA2 can increase the risk of prostate cancer as well as
the other cancers.
• OTHER FACTORS - Certain other factors such as obesity, increased calcium
intake, and dairy foods may increase the risk of prostate cancer.
 SIGNS AND SYMPTOMS
Symptoms of prostate cancer in men can be a bladder and urinary problems that result
in:
• Difficult and repeating urination. Especially during at night time
• Loss of control of the bladder
• The velocity of the urine flow is reduced
• Burning during urination but it is less common
• Haematuria, a condition in which blood passes along with the urine
• Discomfort while in sitting posture because of an enlarged prostate
Other symptoms of prostate cancer:
Blood in semen
Erectile dysfunction
Pain during ejaculation
Swelling of the pelvic area
Numbness in the hips, legs or feet
Bone pain that leads to fractures and doesn’t go away
 DIAGNOSTIC EXAM
• BIOPSY
• BONE SCAN
• CT SCAN
• DIGITAL RECTAL EXAM
• GENETIC TESTS
• MRI
• PROSTASCINT SCAN
• PSA TEST
• ULTRASOUND
 NURSING MANAGEMENT
• MONITOR VITAL SIGNS CLOSELY
• ENCOURAGE FLUID INTAKE TO 3000mL PER DAY
• PERCUSSION/PALPATION OF THE SUPRAPUBIC AREA
• OBSERVATION OF THE FLOW OF URINE, NOTE THE
SIZE AND STRENGTH.
• ENCOURAGE THE PATIENT TO URINATE EVERY 2-4
HOURS AND WHEN IT SUDDENLY FELT.
 MEDICAL MANAGEMENT
• ACTIVE SURVEILLANCE
• SURGERY CHEMOTHERAPY
• EXTERNAL BEAM RADIATION
• BRACHYTHERAPY
• HORMONE THERAPY
• STEREOTACTIC RADIOSURGERY
• CRYOTHERAPY
 SIGNS &
SYMPTOMS
…….
 SIGNS AND SYMPTOMS

FREQUENT INCREASE URINE

URINATION
The enlargement of
AT NIGHT
prostate can place pressure Due to weak or interrupted
on your urinary system urine flow or the need to
strain to empty the bladder

DIFFICULTY BLOOD IN THE

STARTING AND URINE
The enlarged prostate that
MAINTAINING A press on the urethra, which
STEADY STREAM can cause bladder irritation
OF URINE
 SIGNS AND SYMPTOMS

PAINFUL PAINFUL
URINATION
Depending on its size and EJACULATION
location, a tumor may
press on and constrict the
urethra, inhibiting the flow
or urine
DIFFICULTY BONE PAIN
ACHIEVING Commonly felt on the
ERECTION vertebrae, ribs, pelvis, and
femur – most common
symptom
PREVENTION &
SCREENING
…….
 PREVENTION ABOUT PROSTATE
CANCER
There's no sure way to prevent
prostate cancer. Study results often
conflict with each other, and most
studies aren't designed to definitively
prove whether something prevents
prostate cancer. As a result, no clear
ways to prevent prostate cancer have
emerged.
PREVENTION

In general, doctors recommend

that men with an average risk of
prostate cancer make choices that
benefit their overall health if
they're interested in prostate
cancer prevention.
 PREVENTION
Choose a healthy diet:
● Choose a low-fat diet. Foods that contain
fats include meats, nuts, oils and dairy
products, such as milk and cheese.
● Increase the amount of fruits and
vegetables you eat each day. Fruits and
vegetables are full of vitamins and nutrients
that are thought to reduce the risk of prostate
cancer, though research hasn't proved that
any particular nutrient is guaranteed to
reduce your risk.
PREVENTION
• Reduce the amount of dairy
products you eat each day. In studies,
men who ate the most dairy products
— such as milk, cheese and yogurt —
each day had the highest risk of
prostate cancer. But study results have
been mixed, and the risk associated
with dairy products is thought to be
small.
 PREVENTION

● Maintain a healthy weight. Men who are

obese — a body mass index (BMI) of 30
or higher — may have an increased risk of
prostate cancer. If you are overweight or
obese, work on losing weight. You can do
this by reducing the number of calories
you eat each day and increasing the
amount of exercise you do.
PREVENTION

• Exercise most days of the

week. Studies of exercise
and prostate cancer risk have
mostly shown that men who
exercise may have a reduced
risk of prostate cancer.
 PREVENTION
● Talk to your doctor about your
risk. Some men have an increased
risk of prostate cancer. For those
with a very high risk of prostate
cancer, there may be other options
for risk reduction, such as
medications. If you think you have a
high risk of prostate cancer, discuss
it with your doctor.
 SCREENING FOR
PROSTATE
The goal of screening for prostate cancer is to
find cancers that may be at high risk for
spreading if not treated, and to find them
early before they spread. There is no
standard test to screen for prostate cancer.
Two tests that are commonly used to screen
for prostate cancer are described below.
 PROSTATE SPECIFIC ANTIGEN
(PSA) TEST
A blood test called a prostate specific antigen (PSA)
test measures the level of PSA in the blood. PSA is a
substance made by the prostate. The levels of PSA in
the blood can be higher in men who have prostate
cancer. The PSA level may also be elevated in other
conditions that affect the prostate. As a rule, the higher
the PSA level in the blood, the more likely a prostate
problem is present. But many factors, such as age and
race, can affect PSA levels. Some prostate glands
make more PSA than others.
PROSTATE SPECIFIC ANTIGEN
(PSA) TEST
A PSA levels also can be
affected by:
• Certain medical procedures
• Certain medications
• An enlarged prostate
• A prostate infection
 DIGITAL RECTAL
EXAMINATION (DRE)
Digital rectal examination (DRE) is when a
health care provider inserts a gloved,
lubricated finger into a man’s rectum to feel
the prostate for anything abnormal, such as
cancer. If your doctor finds any abnormalities
in the texture, shape or size of the gland, you
may need further tests.
 
TREATMENT &
PROGNOSIS
…….
 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.
Wherein the patient and his partner or family
members should discuss the treatment options in
detail with the urologist and other physicians. The
patient must understand which treatments are
available, how effective each is likely to be, and
what side effects can be expected. The patient
must also weigh all the choices carefully before
making a decision about which course to pursue.
PROSTATE CANCER TREATMENT
Several treatments are available for
prostate cancer. The choice of treatment
depends on age, general medical
condition, and the extent of the tumor
spread. The treatment plan should be
individualized for the patient depending
on his or her feelings about the different
treatments and their potential side
effects.
 For stage I and stage II prostate cancer, surgery is the

SURGERY
most common method of treatment because it
theoretically offers the chance of completely removing
the cancer from the body.
1. 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.

Radical prostatectomy can be performed by open surgery, laparoscopic

surgery, or by robotic surgery (robotic assisted radical prostatectomy).
 TREATMENT
There are various different types of prostate surgery that can be
performed including::
The entire gland, and nearby
Radical Retropubic lymph nodes, is removed
01. Prostatectomy through an incision in the
abdomen.

The entire gland is removed

through an incision between the
Radical Perineal scrotum and the anus. Nearby
02. Prostatectomy
lymph nodes can also be
removed at the same time
through a separate incision in
the abdomen.
 TREATMENT
There are various different types of prostate surgery that can be
performed including::

The entire gland, and nearby

lymph nodes, is removed
through a number of small
Laparoscopic incisions, rather than a single
03. prostatectomy long cut in the abdomen. A thin,
lighted tube known as a
laparoscope is used to remove
the prostate.
 TREATMENT
There are various different types of prostate surgery that can be
performed including::
Part of the gland is removed using a
long, thin device which is inserted
Transurethral Resection of
04. the Prostate (TURP)
through the urethra. TURP may not
remove all of the cancer, but it can
remove tissue that is blocking the
flow of urine.

This procedure is routinely

carried out during prostate
surgery. Lymph nodes in the
Pelvic
05. Lymphadenectomy
pelvis are removed to see if
cancer has spread to them,
indicating that the disease may
have spread to other parts of the
body.
 2. 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.

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.
 3. 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
 4. Watchful Waiting
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.
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
 OTHER THERAPY
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
 PROGNOSIS
In general, the earlier prostate cancer is
caught, the more likely it is for a man to get
successful treatment and remain disease-
free. When it comes to the survival rates
and likelihood of recurrence are based on
averages and won’t necessarily reflect any
individual patient outcome. Overall, the
prognosis for prostate cancer depends on
many factors.
 PROGNOSIS

Stage I, II, III Approximately 80 percent to 85 percent of all

prostate cancers are detected in the local or regional
Prostate Cancer stages, which represent stages I, II and III. Many
men diagnosed and treated at the local or regional
Prognosis stages will be disease-free after five years

Prostate cancers detected at the distant stage have

an average five-year survival rate of 28 percent,
Stage IV Prostate which is much lower than local and regional
cancers of the prostate. This average survival rate
Cancer Prognosis represents stage IV prostate cancers that have
metastasized (spread) beyond nearby areas to lymph
nodes, organs or bones in other parts of the body.
 PROGNOSIS
LONG-TERM PROGNOSIS
The average long-term prognosis for
prostate cancer is quite encouraging.
The following are the average relative
survival rate of all men with prostate
cancer based on the study of the
American Cancer Society
 PROGNOSIS
LONG-TERM PROGNOSIS:
Five years after diagnosis, the average prostate
5-year relative survival cancer patient is about as likely as a man without
rate of nearly 100 percent prostate cancer to still be living.

Ten years after diagnosis, the average prostate

10-year relative survival cancer patient is just 2 percent less likely to survive
rate of nearly 98 percent than a man without prostate cancer.

Fifteen years after diagnosis, the average prostate

15-year relative survival cancer patient is 5 percent less likely to survive than
rate of nearly 95 percent a man without prostate cancer.
 PROGNOSIS
Recurrence
Even if the prostate cancer was treated with an initial
primary therapy (surgery or radiation), there is
always a possibility that the cancer will reoccur.
About 20 percent to-30 percent of men will relapse
(have the cancer detected by a PSA blood test) after
the five-year mark, following the initial therapy.
Hence, the likelihood of recurrence depends on the
extent and aggressiveness of the cancer.
 NURSING
MANAGEMENT
…….
Nursing Diagnosis:
Urinary retention related to urethral obstruction
secondary to prostatic enlargement or tumor and loss of
bladder tone due to prolonged retention
Expected Outcomes:
• Voids at normal intervals
• Reports absence of frequency, urgency, or
bladder fullness
• Displays no palpable suprapubic distention
after voiding
• Maintains balanced intake and output
Nursing Diagnosis:
Urinary retention related to urethral obstruction secondary to
prostatic enlargement or tumor and loss of bladder tone due to
prolonged retention
Nursing Interventions:
1. Determine patient’s usual pattern of urinary function
2. Assess for signs and symptoms of urinary retention: amount and
frequency of urination, suprapubic distention, complaints of urgency
and discomfort
3. Catheterized patient to determine amount of residual urine
4. Initiate measures to treat retention
5. Consult with primary provider regarding intermittent or indwelling
catheterization; assist with procedure as required
6. Monitor catheter function; maintain sterility of closed system; irrigate
as required
7. Prepare patient for surgery if indicated
Nursing Diagnosis:
Imbalanced nutrition: Less than body requirements
related to decreased oral intake because of anorexia,
nausea, and vomiting caused by cancer or its treatment

Expected Outcomes:
• Responds positively to his favourite foods
• Assumes responsibility for his oral hygiene
• Reports absence of nausea and vomiting
• Notes increase I weight after improved
appetite
Nursing Diagnosis:
Imbalanced nutrition: Less than body requirements related to decreased oral
intake because of anorexia, nausea, and vomiting caused by cancer or its
treatment
Nursing Interventions:
1. Assess the amount of food eaten
2. Routinely weigh patient
3. Elicit patient’s explanation of why he is unable to eat
more
4. Cater to his individual food preferences (e.g., avoiding
foods that are too spicy or too cold)
5. Recognized effect of medication or radiation therapy on
appetite
6. Inform patient that alterations in taste can occur
Nursing Diagnosis:
Imbalanced nutrition: Less than body requirements related to decreased oral
intake because of anorexia, nausea, and vomiting caused by cancer or its
treatment
Nursing Interventions:
7. Educate patient about appropriate oral hygiene
interventions
8. Use measures to control nausea and vomiting such as
administering prescribed antiemetic agents, around the clock
if necessary, providing oral hygiene after vomiting episodes,
and providing rest periods after meals
9. Provide frequent small meals and a comfortable and
pleasant environment
10. Assess patient’s ability to obtain and prepare foods
Nursing Diagnosis:
Sexual dysfunction related to effects of therapy:
chemotherapy, hormonal therapy, radiation therapy,
surgery

Expected Outcomes:
• Describes the reasons for changes in sexual functioning
• Discusses with appropriate health care personnel
alternative approaches and methods of sexual expression
• Includes partner in discussions related to changes in
sexual function
Nursing Diagnosis:
Sexual dysfunction related to effects of therapy:
chemotherapy, hormonal therapy, radiation therapy,
surgery
Nursing Interventions:
1. Determine from nursing history what effect patient’s
medical condition is having on his sexual functioning
2. Inform the effects of prostate surgery, 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 Diagnosis:
Acute pain related to progression of disease and
treatment modalities
Expected Outcomes:
• Reports relief of pain
• Expects exacerbations, reports their quality and intensity,
and obtains relief
• Uses pain relief strategies appropriately and effectively
• Identifies strategies to avoid complications of analgesic
use
Nursing Diagnosis:
Acute pain related to progression of disease and
treatment modalities
Nursing Interventions:
1. Evaluate nature of patient’s pain, its location, and intensity using pain
rating scale
2. Avoid activities that aggravate or worsen pain
3. Since pain is usually related to bone metastasis, ensure that patient’s
bed has a bed board on a firm mattress. In addition, protect the
patient from falls/injuries
4. Provide support for affected extremities
5. Administer analgesic or opioid agents at regularly scheduled
intervals as prescribed
6. Initiate bowel program to prevent constipation
Nursing Diagnosis:
Impaired physical mobility related to tissue hypoxia,
malnutrition, and exhaustion and to spinal cord or nerve
compression from metastases

Expected Outcomes:
• Achieves improved physical mobility
• Relates that short term goals are encouraging him
because they are attainable
Nursing Diagnosis:
Impaired physical mobility related to tissue hypoxia, malnutrition,
and exhaustion and to spinal cord or nerve compression from
metastases
Nursing Interventions:
1. Assess for factors causing limited mobility
2. Provide pain relief by administering prescribed
medications
3. Encourage the use of assistive devices such as cane and
walkers
4. Involve significant others in helping patient with range of
motion exercises, positioning, and walking
5. Provide positive reinforcement for achievement of small
gains
Nursing Diagnosis:
Anxiety related to concern and lack of
knowledge about the diagnosis, treatment plan,
and prognosis
Expected Outcomes:
• Appears relaxed
• States that anxiety has been reduced or relieved
• Demonstrates understanding of illness, diagnostic tests,
and treatment when questioned
• Verbalizes adequate coping ability
• Engages in open communication with others
Nursing Diagnosis:
Anxiety related to concern and lack of knowledge about the
diagnosis, treatment plan, and prognosis

Nursing Interventions:
1. Obtain health history to determine the following:
 Patient’s concerns
 His level of understanding of his health problem
 His past experience with cancer
 Whether he knows his diagnosis of malignancy and its
prognosis
 His support systems and coping methods
Nursing Diagnosis:
Anxiety related to concern and lack of knowledge about the
diagnosis, treatment plan, and prognosis

Nursing Interventions:
2. Provide education about diagnosis and treatment plan
 Explain in simple terms what diagnostic tests to expect, how long
they will take, and what will be experienced during each test
 Review treatment pan and encourage patient to ask questions
3. Assess his psychological reaction to his diagnosis/prognosis and
how he has coped with pat stresses
4. Provide information about institutional and community
resources for coping with prostate cancer: social services support
groups, community agencies
THANK YOU
FOR
LISTENING!
…….