Prostatic Cancers

Question 1

Prostate cancer

Answer 1

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

Question 2

Prostate cancer is…

Answer 2

Androgen-dependent adenocarcinoma

• majority of tumors occur in outer aspect of prostate gland
• usually slow-growing
• most common site for metastasis is bone

Question 3

Risk factors

Answer 3

Age after 50 years
Ethnicity: African American
Family history is non-modifiable risk factor (first-degree relative)

Question 4

Probable risk factors

Answer 4

Smoking
BPH
Dietary factors

Question 5

Clinical manifestations

Answer 5

Usually asymptomatic in early stages

Eventually may experience symptoms similar to BPH

Question 6

Symptoms include

Answer 6

Dysuria
Hematuria
Hesitancy
Urgency
Frequency
Intermittency
Dribbling
Nocturia
Retention
Unable to urinate

Question 7

Primary screening tools

Answer 7

PSA blood test

DRE

Question 8

PSA blood test

Answer 8

Elevated levels indicate prostatic pathology, not necessarily cancer
Marker of tumor volume when cancer exists
Also used to monitor success of treatment

Question 9

Normal PSA level

Answer 9

0-4 mcg/L

Question 10

Mild PSA elevation can occur because…

Answer 10

Aging
BPH
Recent ejaculation
Acute/chronic prostatitis
Long bike rides
Cystoscopy
Indwelling urethral catheters
Prostate biopsies

Question 11

Diagnostic studies

Answer 11

*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

Question 12

Radical prostatectomy

Answer 12

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

Question 13

Radical prostatectomy complications

Answer 13

Major complications with ED and incontinence
Hemorrhage
Urinary retention
Infection
Wound dehiscence
DVT
Pulmonary emobli

Question 14

Cryosurgery (cryoablation)

Answer 14

Surgical technique that destroys cancer cells by freezing tissue
Performed as initial and second-line treatment after radiation therapy has failed

Question 15

Cryosurgery complications include

Answer 15

damage to urethra, urethrorectal fistula, urethrocutaneous fistula
tissue sloughing, ED, urinary incontinence, prostatitis, hemorrage

Question 16

External beam readiation

Answer 16

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

Question 17

Brachytherapy

Answer 17

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

Question 18

Chemotherapy

Answer 18

Primarily limited to treatment for those with hormone-resistant prostate cancer in late stages
Goal is mainly palliatvie

Question 19

Radiotherapy

Answer 19

Ra 223 Dichloride
Used when metastasized to bone
Mimics calcium at areas of increased bone turnover

Question 20

Orchiectomy

Answer 20

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

Question 21

Health history

Answer 21

Urinary urgency, frequency, retention with dribbling, hematuria, nocturia
Dysuria, low back pain radiation to legs or pelvis, bone pain

Question 22

Acute intervention

Answer 22

Provide sensitive, caring support to patient and family to cope with cancer diagnosis
Encourage joining a support group and seeking information

Question 23

Health promotion

Answer 23

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