Neoplasms #4 (2)

Question 1

Clinical Manifestations of Prostate Cancer

Answer 1

1. Asymptomatic in early stages
2. Dysuria, hesitancy, dribbling, frequency, uregency, hermaturia, nocturia, retention
3. Enlarged, hard, fixed prostate upon DRE
4. Lumbosacral pain

Question 2

Risk Factors for Prostate Cancer

Answer 2

1. Family History
2. >60 yr
3. African American

Question 3

Screening Methods for Prostate Cancer

Answer 3

1. Age 50
2. Age 45 if AA or family history
3. Digital Rectal Exam (DRE) men >50
4. Serum PSA (Prostate Specific Antigen) levels
5. Normal PSA = 0-4 ng/mL

Question 4

Treatment for Prostate Cancer

Answer 4

1. Surgical Intervention
   
   1. Laparoscopic Radical Prostatectomy
   2. Suprapubic Radical Prostatectomy
   3. Retropubic Radical Prostatectomy:
   4. Abdominal/Perineal Resection of Prostate
   5. Pelvic Lymph Node Dissection
2. Radiation Therapy
3. Hormone Therapy
4. Active Surveillance

Question 5

Laparoscopic Radical Prostatectomy

Answer 5

DaVinci Robot may be utlizied during procedure

Question 6

Suprapublic Radical Prostatectomy

Answer 6

Suprapublic catheter in addition to foley catheter insertion to assist in bladder healing

Question 7

Abdominal/Perineal Resection of Prostate

Answer 7

An abdominal and perineal incision

Question 8

Pelvic Lymph Node Dissection

Answer 8

• Lymph nodes in the pelvis are dissected and assessed for metastsis
• Accompanies most prostate surgical resections

Question 9

Post-operative considerations for prostate cancer surgical options

Answer 9

• Patients will have a foley catheter and a JP drain following procedures above
• Manual and/or continous bladder irrigation of foley catheter is expected
• Most patients are discharged to home with foley catheter in place

Question 10

Hormone Therapy

Answer 10

• Mainstay of treatment for advanced prostate cancer
• Surgical castration (bilateral orchiectomy)
• Chemical castration (administration of hormones to block androgen secretion)

Question 11

Active Surveillance (Watchful Waiting)

Answer 11

• Utilized for patients with low-grade disease who are older than 70, with a life expectancy of less than 10 years
• Treatment is only initiated when patient becomes symptomatic

Question 12

Radiation Therapy

Answer 12

External beam radiation or radioactive seed implants

Question 13

Continuous Closed Bladder Irrigation (Murphy Drip)

Answer 13

A closed system used to introduce solution into the urinary bladder without exposing the system to entry of microorganisms. The continuous bladder irrigation:

1. Maintains patency of the catheter
2. Bathes the linging of the bladder
3. Prevents bladder distention and discomfort from the obstructed drainage
4. Allows for instillation of medication

*Generally associated with surgeries of the prostates and other genitourinary surgical procedures*

Question 14

Triple Lumen Foley Catheter (3-Way)

Answer 14

• three separate openings or lumens
• lumen one: infusion of the irrigant into the bladder
• lumen two: drainage of urine and irrigant into a collection bag
• lumen three: inflation of the balloon anchoring the catheter within the bladder