Prostatic Cancers Flashcards
Prostate cancer
1 in every 6 men will develop it in their lifetime
Most common cancer among men, excluding skin
Second leading cause of cancer death in men
Prostate cancer is…
Androgen-dependent adenocarcinoma
- majority of tumors occur in outer aspect of prostate gland
- usually slow-growing
- most common site for metastasis is bone
Risk factors
Age after 50 years
Ethnicity: African American
Family history is non-modifiable risk factor (first-degree relative)
Probable risk factors
Smoking
BPH
Dietary factors
Clinical manifestations
Usually asymptomatic in early stages
Eventually may experience symptoms similar to BPH
Symptoms include
Dysuria Hematuria Hesitancy Urgency Frequency Intermittency Dribbling Nocturia Retention Unable to urinate
Primary screening tools
PSA blood test
DRE
PSA blood test
Elevated levels indicate prostatic pathology, not necessarily cancer
Marker of tumor volume when cancer exists
Also used to monitor success of treatment
Normal PSA level
0-4 mcg/L
Mild PSA elevation can occur because…
Aging BPH Recent ejaculation Acute/chronic prostatitis Long bike rides Cystoscopy Indwelling urethral catheters Prostate biopsies
Diagnostic studies
*Neither a PSA nor DRE is a definitive diagnostic test
Biopsy of prostate tissue is necessary to confirm diagnosis
Elevated levels of prostatic acid phosphatase (PAP) also indicate prostate cancer
Bone scan, CT, MRI with endorectal probe, TRUS
Radical prostatectomy
Retropubic vs perineal approach
Entire gland, seminal vesicles, and part of bladder neck are removed
Retroperineal lymph node dissection usually is done
Considered most effective for long-term survival
Radical prostatectomy complications
Major complications with ED and incontinence Hemorrhage Urinary retention Infection Wound dehiscence DVT Pulmonary emobli
Cryosurgery (cryoablation)
Surgical technique that destroys cancer cells by freezing tissue
Performed as initial and second-line treatment after radiation therapy has failed
Cryosurgery complications include
damage to urethra, urethrorectal fistula, urethrocutaneous fistula
tissue sloughing, ED, urinary incontinence, prostatitis, hemorrage
External beam readiation
Radiation therapy
Common s/e: changes to skin, GI, GU, sexual (can be acute or delayed)
Most widely used method of radiation for prostate cancer
Used to treat cancer confined to prostate and/or surrounding tissue
Brachytherapy
Radiation therapy One time treatment Common s/e: urinary problems, ED Implantation of radioactive seed into prostate gland by guided transrectal ultrasound Spares surrounding tissue One-time out patient procedure Best suited for early stages
Chemotherapy
Primarily limited to treatment for those with hormone-resistant prostate cancer in late stages
Goal is mainly palliatvie
Radiotherapy
Ra 223 Dichloride
Used when metastasized to bone
Mimics calcium at areas of increased bone turnover
Orchiectomy
Testosterone stimulates growth of prostate cancer
Bilateral orchiectomy may be done alone or in combination with prostatectomy
-rapid relief of bone pain
-can alter physical appearance
-grief
Health history
Urinary urgency, frequency, retention with dribbling, hematuria, nocturia
Dysuria, low back pain radiation to legs or pelvis, bone pain
Acute intervention
Provide sensitive, caring support to patient and family to cope with cancer diagnosis
Encourage joining a support group and seeking information
Health promotion
Encourage annual DRE and PSA screenings starting at age 50 (or earlier if risk factors are present)
-because of increased risk, African American men and other men with family hx should have annual screens beginning at 45
