prostate cancer

Question 1

Prostate cancer etiology

Answer 1

Leading cause of cancer in men (affects 1 in 5 men)
2nd leading cause of cancer death in men
Cancer rates twice as high in blacks as opposed to whites
–Common in N. America and Northwest Europe
–Rare in Asia and S. America

Question 2

Prostate cancer risk factors

Answer 2

1. Age- 70% diagnosed in men > age 65
2. Hormonal influences- men castrated before puberty are at little risk
3. Familial predisposition- (5-10% of cases)
4. Increased dietary fat
5. Viral cause: CMV (cytomegalovirus) and Herpes more common in cancerous prostatic tissue
6. Increased STDs, multiple sex partners, exposure to heavy metals (cadmium)

Question 3

prostate cancer patho

Answer 3

95% of tumors are adenocarcinomas
Begins as discrete, localize hard nodule, often on periphery of gland of posterior lobe
Slow growing
Follows predictable pattern of metastases:
1.Prostatic nodes, to Pelvic nodes, to Bone Marrow, to bone of pelvis, sacrum, and lumbar spine
2. Late stages: lung, liver, adrenals, kidneys

Question 4

prostate cancer diagnostics

Answer 4

digital rectal exam
PSA- prostate Specific antigen
Transrectal Ultrasound 
biopsy confirms diagnosis
biopsy confirms diagnosis
EPCA-2 (early prostate cancer antigen)

Question 5

digital rectal exam DRE

Answer 5

1. Annually by age 50, earlier if higher risk
2. Allows for palpation of the posterior wall of the prostate gland
3. 40% of tumors cannot be felt on rectal exam

Question 6

prostate specific antigen

Answer 6

–Blood Test used to detect a glycoprotein made by the prostate
–Introduction of PSA for screening between 1988 and 1992 led to dramatic increase in incidence rates
–Useful in monitoring response to therapy; can be elevated with non-cancerous conditions like prostatitis, BPH

Question 7

transrectal ultrasound

Answer 7

–Assists with detection and biopsy of nonpalpable tumors

Question 8

early prostate cancer antigen

Answer 8

More specific tumor marker for early prostate cancer

Question 9

prostate cancer clinical manifestations

Answer 9

Early disease: asymptomatic
Later:
1. Sx of urinary obstruction: inability to urinate, difficulty starting or stopping slow, frequency, hematuria, nocturia, UTI
2. Pain in lower back, pelvis, upper thighs, hips
3. Malaise

Question 10

prostate cancer staging

Answer 10

Stage A: confined to gland (microscopic)
Stage B: confined to gland (larger)
Stage C: Involves prostate capsule, urethra, bladder, pelvic lymph nodes, with increased serum acid phosphatase
Stage D: Metastases to bone, extra-pelvic lesions

Question 11

prostate cancer management

Answer 11

watchful waiting in older men?

surgery is the standard treatment

Question 12

prostate cancer surgery management

Answer 12

Cryosurgical Ablation: Cryoprobes positioned around prostate and liquid nitrogen freezes the gland; can be repeated
Laparoscopic Prostatectomy (most common)
Radical Prostatectomy: open procedure with incision

Question 13

suprapubic approach

Answer 13

removes prostate from urethra by way of bladder

Question 14

retropubic approach

Answer 14

Bladder retracted, prostate removed thru incision

Question 15

perineal approach

Answer 15

1. Incision between rectum and scrotum
2. Perineal dressing
3. With radical perineal surgery, muscles, (pudendal nerve) nerves around rectal sheath can lead to greater problems with continence and impotence post-op

Question 16

post op prostatectomy

Answer 16

–Retrograde Ejaculations: removal of tissue at bladder neck allows seminal fluid to travel up into bladder rather than down urethra
–ED (Erectile Dysfunction):
Temporary or permanent depending on damage to pudendal nerve
If temporary, function usually returns in 3-12 mos.

Question 17

urinary incontinence teaching for prostate cancer

Answer 17

1. Standard post-op care (Cough & Deep Breathe, leg exercises (dorsiflexion, plantar flexion), etc.)
2. Teach care of urinary catheter and drainage bag-leg bag-discharged with catheter
3. Avoid straining, rectal temps and meds, enemas
4. May have drain (penrose or JP)

Question 18

bilateral orchiectomy

Answer 18

removal of testicles

Palliative: performed in order to arrest disease by removing source of testosterone

Question 19

chemo for prostate cancer

Answer 19

not proven for prostatic cancer

Question 20

prostate cancer radiation

Answer 20

1. Used as an alternative curative treatment for locally contained tumors
2. As adjunct to radical prostatectomy when nodes or margins are positive
3. Use for palliation (bone metastasis)

Question 21

prostate cancer radioactive seed implantation

Answer 21

1. Done on ambulatory basis
2. Effective for early stage prostate cancer
3. Well tolerated

Question 22

prostate cancer hormonal therapy

Answer 22

–Decrease testosterone levels by:

1. Bilateral Orchiectomy
2. OR Estrogens (Diethystilbestrol) – Inhibit release of LH from pituitary gland
3. Gonadotropin- releasing hormone agonist: (Lupron) suppresses the release of LH by pituitary
4. Androgen blocking agent (Fluteamide) – blocks uptake of androgens at prostate cancer site
5. Degarelix: decreases levels of testosterone

Question 23

prostate cancer prognosis

Answer 23

–Usually slow growing in “older” men (even stage C can have long survival 8-10 years)
–Can progress rapidly in younger men, higher levels of testosterone

Question 24

prostate cancer prevention

Answer 24

–Secondary Prevention: Early Detection
–PSA at age 50 yrs. or age 45 yrs. if high risk
–DRE annually