10.3 Prostate/Testicular Cancer

Question 1

Prostate Cancer

Answer 1

• Most common cancer in American men
• Most common in older adults, African American,
• Prostate is the size of a walnut
• Slow growing, and can be completely removed or managed if it is diagnosed before it spreads.
• Adenocarcinoma is the most common type of prostate cancer

Risks
- 65+
- Family history (including BRAC2 - gene that makes protein for tumor suppression. Also repairs damaged DNA)
- High fat/meat diet
- High body weight
- Ethnicity
- Environmental exposure

Question 2

Benign Prostatic Hyperplasia (BPH)

Answer 2

• Does not increase risk of prostate cancer but symptoms can be similar

Question 3

Clinical Manifestations of Prostate Cancer

Answer 3

• Urinary frequency (nocturia)
• Strong urge to urinate
• Difficulty starting to urinate
• Weak/slow stream
• Interrupted urine streams
• Not able to completely empty bladder
• Hematuria, Dysuria
• Pain when sitting (due to enlarged prostate)
• Painful ejaculation
• Stiffness/pain in hips, back or pelvis that doesn’t go away

Question 4

Prostate Specific Antigen (PSA)

Answer 4

• Not enough to detect cancer because normal and malignant cells both produce it
• UTI and prostatitis can also cause elevated levels
• Medications can lower PTA (ones used to treat BPH)
• IN GENERAL THOUGH THE HIGHER THE PSA (OR CONTINOUS INCREASE OVERTIME) THERE IS HIGHER CHANCE OF PROSTATE CANCER (over 4.0)

Question 5

Prostate Cancer Treatment

Answer 5

• Slow growing and unlikely to spread outside of prostate
• Do not need to be treated right away (watchful waiting)

Surgery
- Pelvic Lymphadenectomy (removal of lymph nodes)
- Radical Prostatectomy (removal of prostate)

Radiation Therapy
- Can cause proctitis/cystitis and dermatitis
- Will need medications to help reduce urinary retention.
- Internal radiation can cause prostate swelling and chance urinary patterns

Hormone Therapy
- Decrease testosterone (slower disease progress)

Chemotherapy
- Last resort

Question 6

Transurethral Resection of Prostate (TURP)

Answer 6

• Surgery to remove prostate tissue using a resectoscope inserted into urethra.
• Palliative to relieve symptoms caused by tumor.

Post-Op
- Dressing changes and watchful of catheter (left for 2 weeks) and drains (left for 2-3 days)
- Most men will have urinary incontinence for a few months after surgery and ED is common.

Nursing Interventions
- Clean catheter daily with mild soap
- Force fluids
- Drains (JP drains)
- Secure catheter to leg
- Pain management

• Kegel exercises recommended for urinary incontinence

Question 7

Testicular Cancer

Answer 7

• Most common in 15-34 (peaks at 30)
• Most common in Caucasian men
• Left side is more prone than right side
• Most start in THE GERM CELLS (cells that make sperm)

2 Types
Seminoma Tumor - Most common less aggressive

Risks
- Cryptorchidism/Orchitis
- Family history
- Maternal exposure to DIETHYLSTILBESTEROL (DES) during pregnancy
- Environmental exposure to insecticides

S/S
- Solid painless lump in testicle
- Swelling of testicle
- Pain/dull ache in testicle
- Feeling of heaviness in scrotum/abdomen
- Buildup of fluid in scrotum
- Breast soreness (gynecomastia)

Diagnosis
- Testicular cancer may cause increased levels of AFP and HCG. LDH is a less specific test for testicular cancer.

Treatment
- Orchiectomy is the first line treatment

• TEACH PATIENTS OF SELF EXAMINATION FOR TESTICULAR CANCER

Question 8

Cryptorchidism/Orchitis

Answer 8

Cryptorchidism
- Absence of 1 or both testes (common birth defect)

Orchitis
- Swelling/inflammation of 1 or both testes
S/S
- Blood in semen
- Discharge from penis
- Groin pain
- Pain with ejaculation
- Dysuria
- Scrotal swelling