Med-Surg: Chapter 66: Prostate Cancer Flashcards
Epidemiology
- 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
Risk Factors
- genetic and environmental factors
- family hx
- diets high in red meat
- high consumption of calcium
- high BMI
What Type of diet may play a protective role against the development of prostate cancer?
diet that consists of vegetables, vitamin E, lycopene, selenium, and antioxidants
Pathophysiology
- 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
Prostate Cancer
- slow growing
- can metastasize to the lymph nodes, bone, rectum, and bladder
- may be curable when localized but responds to tx even when widespread
Clinical Manifestations
- 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
Presenting Symptoms of Local Disease
- asymptomatic
- elevated PSA
- weak urinary stream
- hesitancy
- sensation of incomplete emptying of bladder
- frequency
- urgency
- urge incontinence
- UTI
Presenting Symptoms of Locally Invasive Disease
- 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)
Diagnosis
- 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)
Important Discussion Points Regarding the Decision-Making Process of Prostate Screening and Treatment
- 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
PSA Screening
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
Gleason Scoring System
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
Tumor, Nodes, Metastasis Classification (TNM)
alternative scoring system
>T: size and location of tumor
>N: spread to lymph nodes
>M: presence of metastasis
Treatment Options for Prostate Cancer
- radiation
- cryotherapy
- ablative hormone therapy
- chemotherapy
- surgery
Treatment: Radiation
-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)
External-beam radiation
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
Brachytherapy
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
What should a man do when receiving brachytherapy?
use a condom during sex to avoid exposing partner to radiation
Cryotherapy
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
Ablative Hormone Therapy
- 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
Chemotherapy
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
Surgical Management: Radical Prostatectomy
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
Assessment and Analysis
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
Nursing DIagnoses
- Risk for infection r/t surgical intervention/ pharmacological intervention
- Sexual dysfunction r/t the disease process/ surgical intervention
Nursing Assessments
> 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
Nursing Actions
> 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
Postop surgical care
> 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
Teaching
> 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)
Which foods have selenium
- oysters
- tune
- whole-wheat bread
- sunflower seeds
Evaluating Care Outcomes
- 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
Prostate: Risk Factors, S/S, Metastasis
> Risk Factors:
- age
- family hx
- pesticides
> S/S:
- pelvic/rectal pain
- dysuria
- nocturia
- erectile dysfunction
> Metastasis:
-bones, lymph nodes, rectum, bladder
