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Adult Medical - Surgical Nursing

Adult Medical - Surgical Nursing. Reproductive Health Module: Prostate Cancer. Prostate Cancer: Description. Cancer of the prostate gland is the most common cancer in men Early detection (screening) is simple and potentially life-saving

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Adult Medical - Surgical Nursing

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  1. Adult Medical - Surgical Nursing Reproductive Health Module: Prostate Cancer

  2. Prostate Cancer: Description • Cancer of the prostate gland is the most common cancer in men • Early detection (screening) is simple and potentially life-saving • All men > 50 years are advised to be screened annually

  3. Prostate Cancer: Screening • Regular digital rectal examination: • The prostate gland is felt as hard, stony, fixed, nodular (benign hypertrophy is soft, rubbery) • ↑ Prostate Specific Antigen (PSA): • (Also elevated with benign prostatic hypertrophy therefore does not definitively diagnose malignancy)

  4. Prostate Cancer: Aetiology • Unknown cause • Hormone dependent gland (androgen) • Genetic tendency • Increased incidence with age • High fat diet • Smoking • Any factors reducing immunity

  5. Prostate Cancer: Pathophysiology • Mutation and abnormal cell division • Enlargement encroaching on the urethra and bladder neck → obstruction • Proliferation to surrounding tissues (rectum, seminal vesicles) • Metastastic spread to lymph nodes and bone (hip, spine)

  6. Prostate Cancer: Clinical Manifestations • Symptoms may not be evident until the condition is advanced: • Frequency, urgency, nocturia • Poor stream • Dribbling • Inadequate bladder emptying • Haematuria • Weight loss, malaise, anaemia • Rectal/ perineal discomfort • Back/ hip pain

  7. Prostate Cancer: Diagnosis • Rectal examination (hard stony fixed nodular prostate gland) • ↑ PSA (proportional to prostatic mass: also monitors effectiveness of treatment) • Needle biopsy (transperineal/ ultrasound control): histology of prostate tissue (staging) • Prostatic fluid sample (histology/ culture) • Trans-rectal ultrasound • KFT, urography, • Bone scan/ Xray

  8. Prostate Cancer: Staging • Gleason Score: • A score (1-5) is assigned to the most predominant architectural pattern of the gland and (1-5) for the second most predominant. • Reported as: 2 + 4 (example). Combined value up to 10 • The higher the value, the more aggressive the tumour • Lower scores indicate well-differentiated, less aggressive • Higher scores indicate undifferentiated, aggressive • Combined score of 8 – 10 shows high-grade cancer

  9. Prostate Cancer: Management • Surgery • Radiation therapy • Hormonal therapy • Chemotherapy • A combination of therapies

  10. Prostate Cancer: Surgery • Radical Prostatectomy: removal of the prostate and seminal vesicles • May be performed in early stage (10 year or more life-expectancy) • Results in impotence • If surgery not tolerated cryotherapy may be used to freeze • Orchidectomy may be also performed: (↓ androgen)

  11. Prostate Cancer: Radiation Therapy • If detected early: • Linear Accelerator (6-7 week therapy) or • Implantation of radioactive iodine or palladium seeds: • Requires minimal exposure to others: • Use of condom/ strain urine • Temporary side-effects of radiotherapy: proctitis, enteritis, cystitis

  12. Prostate Cancer: Hormonal Therapy • The prostate is androgen dependent therefore androgen withdrawal → atrophy of prostatic epithelium: • Reduces size of tumour • Reduces pain from metastases/ promotes well-being • Oestrogens inhibit gonadotrophin therefore reduce androgen production • Anti-androgen drug: Eulexin • Orchidectomy: promotes androgen withdrawal since 93% of testosterone (androgen) is produced by the testes

  13. Prostate Cancer: Psychological Impact • There is a severe emotional self-image impact from: • Surgery (prostatectomy) inducing impotence • Hormone changes • Orchidectomy • Fear and apprehension related to the diagnosis

  14. Prostate Cancer: Nursing Considerations • Public health awareness of the importance of regular screening for early detection • Emotional and psychological support to patient and family: specialist counselling • Patient awareness/ precautions related to: • Radiotherapy/ chemotherapy • The effects of hormonal therapy • Nursing care surrounding surgery

  15. Surgery: Radical Prostatectomy

  16. Prostatectomy:Potential Complications • Haemorrhage (radical surgery; the prostatic tumour is very vascular) • Clot retention: risk of obstruction of urine flow by clots forming in the catheter lumen • Deep venous thrombosis/ pulmonary embolism

  17. Prostatectomy: Management • ICU • IVI and blood transfusion as required • A 3-way Foley catheter is used for continuous irrigation of the bladder with saline to flush away clots • IV antibiotics (including Gentamycin to prevent gram negative shock) (also given when catheter removed) • Physio • Anti-embolism stockings

  18. Prostatectomy: Nursing Considerations • ICU; IVI and blood transfusion as required • Careful monitoring of vital signs • Accurate intake/ output including irrigation • Monitor urine colour (for ↑ haemorrhage) • Monitor drainage: “milk” clots to encourage urine flow (note supra-pubic distension, pain, restlessness) • Bladder washout if required (analgesia important) • Encourage oral fluids. Physio. Antibiotics

  19. Prostate Cancer: Follow-up • Regular follow-up: • Rectal examination • PSA • Bone scans • Physical examination for lymph gland involvement • CBC: monitor cell count (risk of bone marrow suppression (anaemia/ thrombocytopaenia/ leukopenia) following radiotherapy or chemotherapy)

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