Week 9 Prostate Cancer Flashcards
What is prostate cancer?
- A malignant tumour of the prostate gland
- Slow Growing
- androgen- dependent adenocarcinoma
- Many men die with prostate cancer but not from it
Signs and symptoms of prostate cancer. Early and Late
Early: asymptotic
Late: symptoms are similar to BPH
Late symptoms of prostate cancer (10)
- dysuria
- hesitancy
- dribbling
- frequency
- urgency
- hematuria
- nocturia
- retention
- interruption of urinary stream
- Inability to urinate
Diagnostics for Prostate cancer
- PSA levels - increase
- Digital Rectum Exam - prostate will feel asymmetrical, hard and nodular
- TRUS scan and biopsy for confirmation
How do we know if cancer metastasize
- Pain in the lumbosacral are that radiates down to hips or legs
- spreads through lymph system and spread through blood stream
Is Prostate cancer curable?
if its caught in an early stage it is curable
When is conservative treatment appropriate? (3)
- When patient has a life expectancy of less than 10 years ( low risk of dying of the disease)
- Serious coexisting medical conditions
- low grade, low-stage tumour
–> these patients are usually followed with frequent PSA measurements, along with DRE, to monitor for progress of the disease.
What are the 3 surgery for prostate cancer?
- Radical prostatectomy
- Nerve- sparing procedure
- Cryosurgery
what is radical prostectomy?
- the entire prostate gland, seminal vesicles, and part of bladder neck are surgically removed
- the entire prostate is removed because cancer tends to be in many different locations within the gland.
when is surgery not recommended?
not an option for advanced stage disease (except to relieved symptoms associated with obstruction) because metastasis has already occurred.
what are the two most common approach for radical prostatectomy?
retropubic and perineal resection
what is retropubic resection?
- a low midline abdominal incision is made to access the prostate gland
what is perineal resection
an incision is made between the scrotum and the anus.
post op radical prostatectomy
- after surgery the patient has a large in-dwelling catheter with a 30-mL balloon placed in the bladder via the urethra.
- This catheter is typically left in place for 1-2 weeks.
post op care for radical prostatectomy
- make sure wound is healing
- make sure perineal approach incision is clean and dry and not contaminated with stool
what are major complication for post op care for radical prostatectomy
- erectile dysfunction - may have cut the nerves that control erection
- Incontinents - have to remove neck of bladder and sow it back to the urethra
post op education
- overtime bladder adjust and most men do gain control
- Encourage kegel exercises to strengthen urinary sphincter
What is nerve-sparing procedure
- remove prostate and preserve neuromuscular
- hope to remove all prostate but hope that nerves intact to allow for an erection
Nerve-Sparing procedure is not indicated in patients with
patients with cancer outside of their prostate gland
What is Cryosurgery
- a surgical technique for prostate cancer that destroys cancer cells by freezing the tissue.
- A TRUS probe is inserted to visualize the prostate gland. The prob contains liquid nitrogen which delivers freezing temperature destroying the tissues
- Does not involve any incisions
- requires general or spinal anaesthesia
Cryosurgery complications
- damage to the urethra
- opening between urethra and the skin (rare)
- opening between urethra and rectum (rare)
Radiation therapy
a common treatments option for prostate cancer, especially for men older than 70, patients who are poor surgical risk, or those who with to avoid surgery
Radiation: External beam Irradiation
- this therapy can be used to treat patients with prostate cancer confined to the prostate ;or surrounding tissue.
- Patients are treated on an outpatient basis 5 days a week for 4 to 8 weeks.
Radiation: Brachytherapy
- involves the implantation of the radioactive seeds into the prostate gland, allowing higher radiation doses directly in the tissue while sparing the surrounding tissue.
- The radioactive seeds is placed in the prostate gland with a needle through a grid template guided by TRUS.
