Objectives The learner will be able to: • Identify diagnostic methods for determining the presence and stage of prostate cancer. • Describe possible treatment modalities for prostate cancer. • Discuss nursing implications for a patient newly diagnosed with prostate cancer.
Epidemiology • 6 in 10 men are 65 and >; average age at diagnosis is 66 • African American • First-degree relative with prostate cancer • Genetics • BRCA1 and BRCA2 genes • HPC1 gene • 1 out of 7 men will be diagnosed in their lifetime with prostate cancer
Screening • African Americans or first-degree relative • Annual digital rectal exam (DRE) • Annual prostate specific antigen (PSA) blood test • Controversial • May reveal clinically insignificant tumors • Treatment of insignificant tumors • Adverse side effects • Diminished quality of life
Diagnostics • DRE • Elevated PSA • Transrectal ultrasound (TRUS) • Biopsy (often combined with TRUS) • Pelvic magnetic resonance imaging (MRI) • Bone scan
Gleason Score • Biopsy samples examined under microscope • The most common cell type is graded and the second most common cell type is graded. • Well-differentiated (1) • Moderately differentiated (2) • Poorly differentiated (34) • Not recognized as prostate cell (5) • These two numbers are added together.
Staging • Stage I • Involves small area of prostate gland • Stage II • Confined to prostate gland, but may involve both lobes • Stage III • Extends outside prostate capsule • Stage IV • Involves structures adjacent to the prostate
Treatment Options • “Watchful waiting” • Surgical removal of the prostate (prostatectomy) • Radiation therapy • External beam • Brachytherapy • Cryosurgery • Pharmacotherapy
“Watchful Waiting” • For localized, low-grade tumors • DRE determines if prostate is enlarging. • Rapid PSA elevation may indicate a more aggressive cell type. • Rate of change determines if the client can continue to be monitored or if more aggressive treatment should begin.
Trans-Urethral Resection (TURP) • Scope and cauterization through urethra • Removes prostate in pieces • Does not “cure” prostate cancer
Prostatectomy • Surgical removal of prostate • Open incision • Retropubic (lower abdominal incision) • Perineal (incision between scrotum and rectum) • Laparoscopy • Radical prostatectomy • Prostate, seminal vesicles, ejaculatory ducts, lymph node sampling
Postoperative Care • Monitor blood loss. • Maintain catheter patency (NS irrigation). • DO NOT REMOVE CATHETER. • Monitor fluid/electrolyte status. • Provide wound care. • Monitor signs of infection. • Monitor complications of immobility.
Discharge Education • Indwelling catheter care • Maintain fluid intake 2 L/day. • Walk 46 times/day; encourage deep breathing exercises/use of incentive spirometer • Report fever or chills. • Report leg pain or edema. • Report bright red urine, multiple clots, decreased urine production.
Radiation Therapy • External beam • X-rays are delivered through tissues from three angles. • Non-prostate tissues are protected. • Client is not radioactive. • Surgery is not a subsequent option after radiation therapy.
Radiation Therapy (cont.) • Brachytherapy (temporary or permanent) • Needles are inserted through the perineum into prostate. • Radioactive “seeds” are inserted through needles. • Permanent seeds may be lost through urethra (voiding or intercourse). • Client is radioactive. • Surgery is not an option after radiation therapy.
Cryosurgery • Probes are inserted through skin into prostate. • Gas is delivered through probe, which freezes local tissue. • Urethra is protected by circulating warm water. • Reserved for small tumors • May need to be repeated
Pharmacotherapy • Hormone-blocking therapy • Estrogen • Ketoconazole • Leutinizing hormone-releasing hormone (LHRH) • Leuprolide • Goserelin • Chemotherapy
Long-Term Complications • Urinary incontinence • Sexual dysfunction • Bladder outlet obstruction • Leg and scrotal edema • Pain (metastasis to bone)
References American Cancer Society. (2014). Cancer facts and figures 2014. Atlanta, GA: Author. American Cancer Society. (2013). American Cancer Society guidelines for the early detection of cancer: Prostate. Retrieved from http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer Brawley, O.W., & Barnes, S. (2001). The epidemiology of prostate cancer in the United States. Seminars in Oncology Nursing, 17, 7277. Cooney, K.A., McCarthy, J.D., Lange, E., Huang, L., Miesfeldt, S., Montie, J.E., … Lange, K. (1997). Prostate cancer susceptibility locus on chromosome 1q: A confirmatory study. Journal of the National Cancer Institute, 89, 955 959. Ekman, P. (1999). Genetic and environmental factors in prostate cancer genesis: Identifying high-risk cohorts. European Urology, 35, 362369.
References (cont.) Greene, F.L., Page, D.L., Fleming, I.D., Fritz, A., Balch, C.M., Haller, D.G., & Morrow, M. (Eds.). (2002). AJCC cancer staging manual (6th ed.). New York, NY: Springer-Verlag. Held-Warmkessel, J. (2005). Prostate cancer. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer nursing: Principles and practice (6th ed., pp. 15521580). Sudbury, MA: Jones and Bartlett. O’Rourke, M.E. (2006). Nursing care of the client with cancers of the urinary system. In J.K. Itano & K.N. Taoka (Eds.), Core curriculum for oncology nursing (4th ed., pp. 584614). St. Louis, MO: Elsevier Saunders. Scott, R., Mutchnik, D.L., Laskowski, T.Z., & Schmallhorst, W.R. (1969). Carcinoma of the prostate in elderly men: Incidence, growth characteristics and clinical significance. Journal of Urology, 101, 602607. Stroller, M.L., & Carroll, P.R. (2003). Urology. In L.M. Tierney, S.J. McPhee, & M.A. Papadakis (Eds.), CMDT: Current medical diagnosis and treatment. (42nd ed., pp. 903945). New York, NY: Lange Medical Books/McGraw-Hill.