Med-Surg: Chapter 66: Prostate Cancer

Question 1

Epidemiology

Answer 1

• most commonly diagnosed cancers in men
• 81% have localized prostate cancer
• smaller percentage having regional or metastasized cancer
• African American males have have greater incidence
• most diagnosed are over 65

Question 2

Risk Factors

Answer 2

• genetic and environmental factors
• family hx
• diets high in red meat
• high consumption of calcium
• high BMI

Question 3

What Type of diet may play a protective role against the development of prostate cancer?

Answer 3

diet that consists of vegetables, vitamin E, lycopene, selenium, and antioxidants

Question 4

Pathophysiology

Answer 4

• sow-growing cancer
• tumors that develop in the prostate tend to develop on the periphery of the gland, which does not obstruct the flow of urine; hence, they go unnoticed until there is associated pain
• prostate cancer can metastasize to the lymph nodes, bone, rectum, and bladder
• may be curable when localized but responds to treatment even when widespread
• in cases were the cancer has metastasized to the bone, patients may still experience an extended survival rate

Question 5

Prostate Cancer

Answer 5

• slow growing
• can metastasize to the lymph nodes, bone, rectum, and bladder
• may be curable when localized but responds to tx even when widespread

Question 6

Clinical Manifestations

Answer 6

• in early stages, may not cause any s/s
• as it advances, symptoms can develop
• may vary on the basis of local or invasive disease

Question 7

Presenting Symptoms of Local Disease

Answer 7

• asymptomatic
• elevated PSA
• weak urinary stream
• hesitancy
• sensation of incomplete emptying of bladder
• frequency
• urgency
• urge incontinence
• UTI

Question 8

Presenting Symptoms of Locally Invasive Disease

Answer 8

• hematuria (blood in urine)
• dysuria
• perineal or suprapubic pain
• erectile dysfunction
• incontinence
• loin pain or anuria resulting from obstruction of the ureters
• symptoms of renal failure
• hemospermia (blood in semen)
• rectal symptoms; tenesmus (rectal pain or cramping, a sensation of incomplete defecation)

Question 9

Diagnosis

Answer 9

• controversial
• digital rectal exams (DREs) beginning at age 50 and on annual basis
• prostate-specific antigen (PSA) gold standards for detection (look at readings month to month)
• if abnormalities are found n the DRE and PSA, next step is prostatic biopsy (then graded with the Gleason Scoring System)

Question 10

Important Discussion Points Regarding the Decision-Making Process of Prostate Screening and Treatment

Answer 10

• there is conflicting evidence that screening may reduce the risk of death
• PSA and DRE can give a false-positive or a false-negative result
• if prostate cancer is present, the PSA will detect it earlier than no screening at all
• abnormal screening results may result in biopsies, which are painful and can cause complications such as bleeding or infection
• the treatment of prostate cancer can lead to complications such as erectile dysfunction, incontinence, and bowel problems
• immediate treatment of prostate cancer is not always necessary

Question 11

PSA Screening

Answer 11

Prostate-specific antigen

• is a protein produced by the prostate gland and may be considered a tumor marker
• critical cutoff point is 4 ng/mL; man with a PSA of 4 to 10 ng/mL has 20-25% chance of being diagnosed
• greater than 10% increases chances by 60%
• levels of PSA are affected by age
• look at serial PSAs from month to month rather than just one reading

Question 12

Gleason Scoring System

Answer 12

differentiates the diagnosis of prostate cancer into 5 different grades
>Grade 1: tissue is well differentiated and most likely results in best prognosis; greatest chance of cure
>Grade 5: poorly differentiated cancer with a poor prognosis
-tissue samples from two different sites are graded separately and both scores are added together; highest score is a 10

Question 13

Tumor, Nodes, Metastasis Classification (TNM)

Answer 13

alternative scoring system
>T: size and location of tumor
>N: spread to lymph nodes
>M: presence of metastasis

Question 14

Treatment Options for Prostate Cancer

Answer 14

• radiation
• cryotherapy
• ablative hormone therapy
• chemotherapy
• surgery

Question 15

Treatment: Radiation

Answer 15

-nonsurgical option
-may be used after surgery if there is evidence that the cancer has metastasized
>Two options:
-external-beam radiation (aimed at the tumor)
-brachytherapy (surgical implantation of small radioactive pellets into the prostate)

Question 16

External-beam radiation

Answer 16

involves high-energy radiation that targets the prostate tumor

• can include associated lymph nodes
• time-consuming; tx is repeated at least 5 times a week for 8 weeks
• can be delivered via CyberKnife; robotic assisted system that allows the delivery of high doses of radiation with precise accuracy
• may result in incontinence and/or impotence

Question 17

Brachytherapy

Answer 17

procedure that places radioactive seeds or pellets in the prostate through the perineum; the therapy can be targeted at a precise area

• pellets left in place permanently; lose reactivity overtime
• abstain from sex for 2 weeks, at the end of 2 weeks, wear a condom to protect partner from radiation exposure
• this therapy is used with cancer that has not metastasized outside the prostate
• may result in incontinence and/or impotence

Question 18

What should a man do when receiving brachytherapy?

Answer 18

use a condom during sex to avoid exposing partner to radiation

Question 19

Cryotherapy

Answer 19

liquid nitrogen is delivered into the prostate through the perineum using metal probes to freeze the prostate

• early-stage treatment
• used when other treatments have failed
• not used often; needs to be repeated
• may result in impotence, incontinence, and rectal complications

Question 20

Ablative Hormone Therapy

Answer 20

• used in men whose cancer has metastasized into the lymph nodes or bones
• ablative =”suppression of”; suppression of testosterone
• testosterone is an androgen that can promote the growth of tumors; suppression may lead to the slowing of tumor growth and provide symptom relief
• considered neoadjuvant therapy when it is used to shrink the prostate before radiation treatment

Question 21

Chemotherapy

Answer 21

utilized in advanced prostate cancer

• used in men who no longer respond to ablative hormone therapy; known as hormone-refractory prostate cancer
• given in pill form or IV
• given in cycles with a treatment period followed by rest period; vary from daily to weekly or every 3 to 4 months

Question 22

Surgical Management: Radical Prostatectomy

Answer 22

the patients prostate and seminal vesicles are removed under general anesthesia
-if necessary, may remove pelvic lymph nodes

> open retropubic technique: surgeon removes the prostate and lymph nodes through a single abdominal incision

> laparoscopic technique: surgeon removes prostate and lymph nodes through a few small abdominal incisions
-variation: robot-assisted prostatectomy in which the surgeon directs the laparoscopic procedure from a console

> Perineal approach: incision is made between the scrotum and the anus

• less pain
• does not allow access to lymph nodes that drain the prostate

-may result in impotence

Question 23

Assessment and Analysis

Answer 23

clinical manifestations of prostate cancer are not evident until the disease has been present for a long period of time

• slow-growing cancer developing on the periphery of the prostate gland, so it does not obstruct the flow of urine, which allows it to go unnoticed until there is associated pain
• pain is due to obstruction of urine flow and bladder distention resulting from compression of the urethra

Question 24

Nursing DIagnoses

Answer 24

• Risk for infection r/t surgical intervention/ pharmacological intervention
• Sexual dysfunction r/t the disease process/ surgical intervention

Question 25

Nursing Assessments

Answer 25

> Risk Factors:

• African American Men
• men 55 or older
• family hx of prostate cancer
• men with diet low in fruits and vegetables at higher risk

> PSA levels
-a PSA level of 4 ng/mL or greater requires further assessment

> DRE results
-a large, palpable prostate on examination combined with a high PSA level requires further assessment

> Urinary Symptoms
-obstruction of urine flow, a weak stream, and a distended bladder may = an enlarged prostate that requires further assessment—-PSA and DRE

Question 26

Nursing Actions

Answer 26

> Administer medication as ordered

• Ablative hormone therapy: suppresses androgens, which promote tumor growth, thus slowing tumor growth
• Chemotherapy: targeted chemotherapy to destroy cancer cells once ablative hormone therapy is no longer effective

Question 27

Postop surgical care

Answer 27

> Aseptic wound care after prostatectomy
Manage bladder irrigation if present: helps remove blood clots to ensure the free flow of urine
Administer stool softeners: prevent straining during bowel movements

Question 28

Teaching

Answer 28

> Education regarding disease process
-improve compliance and potential positive outcome

> Brachytherapy
-keep the patient and significant other safe by explaining the importance of abstention from sex for 2 weeks following the start of treatment and then condom use to protect the patient’s partner from radiation

> Chemotherapy/Radiation
-explain possible adverse effects so that the patient may be better prepared as to what to expect

> Signs of Infection

• s/s of possible postsurgical infection; fever, increasing pain, swelling, bleeding, nausea, vomiting
• instruct to contact healthcare provider or go to ED if symptoms severe

> Prevention:

• increased risk associated with high consumption of calcium or the ingestion of greater than 7 multivitamins a week
• increased consumption of foods with selenium (oysters, tuna, whole-wheat bread, or sunflower seeds)

Question 29

Which foods have selenium

Answer 29

• oysters
• tune
• whole-wheat bread
• sunflower seeds

Question 30

Evaluating Care Outcomes

Answer 30

• prostate cancer responds well to treatment
• may be curable when localized but responds to treatment even when widespread

> a well-managed patient:

• proactive behaviors: regular screening
• avoiding high consumption of calcium and high-dose multivitamins
• eat foods containing selenium (oysters, tuna, whole-wheat bread, and sunflower seeds)
• good understanding of disease process and treatment options
• best outcomes= good response to treatment with normal sexual functioning, normal urination, and no incontinence

Question 31

Prostate: Risk Factors, S/S, Metastasis

Answer 31

> Risk Factors:

• age
• family hx
• pesticides

> S/S:

• pelvic/rectal pain
• dysuria
• nocturia
• erectile dysfunction

> Metastasis:
-bones, lymph nodes, rectum, bladder