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Prostate

Cancer

What is a Prostate?
The Prostate is a large gland of 30-50 smaller
glands and bundles of smooth muscle
It produces a fluid called semen that contains
sperm
It is located just beneath the urinary bladder and
is about the size of a walnut

Prostate Cancer
A disease in which the cells of the prostate become abnormal and
start to grow uncontrollably, forming tumors (Fallon, pg 2774-2779).
Mortality from Prostate cancer is the second most common cause of
cancer death in men (Jones, 2013).
Prostate cancer is usually multifocal and slow growing
Most prostate cancers are adenocarcinomas
PSA (Prostate Specific Antigen) is used to monitor the progression of
the disease, a score <4.0 ng/mL is considered to be normal
According to the National Cancer Institute, Prostate Cancer can be
grouped into 3 different stages.
1. Local: no sign that the cancer has spread outside of the prostate
2. Regional: those that have spread to nearby areas including
the lymph nodes
3. Distant: those that spread to distant lymph nodes,
bones, or other organs

Prostate Cancer

Risk Factors for Prostate


Cancer
Age (2/3rds of cases happen in men > 65 years of
age)
Race (African Americans have the highest risk)
Family history (5-10% of cases)
Diets high in red meat, calcium, high fat, and dairy
Obesity
Painters, farmers, Industrial workers, and men
exposed to Agent Orange (Herbicide used during
Vietnam War)
Alcohol abuse
Male sex hormone levels
Presence of inflammation (Prostatitis)
Environmental factors

Symptoms/
Assessment

Asymptomatic in early stages, usually found during rectal exam by


primary care provider
Hard, pea-sized nodules palpated on prostate
Gross, painless hematuria
Weak or interrupted flow of urine
Nocturia
Difficulty starting urination
Inability to urinate standing up
Urinary retention
Painful or burning sensation during urination or ejaculation
Persistent bone pain radiating to lower back, hips or thighs
Impotence
Weight loss
Loss of Appetite
Weakness or paralysis in lower limbs

Assessment

Diagnosis
DRE (Digital Rectal Exam): lubricated gloved finger into the rectum to
palpate prostate for lumps
*If any abnormalities are noted, additional tests
are completed
CBC (Complete Blood Count): protein markers such
as PSA (prostate-specific antigen)
Transrectal Ultrasound: a small transducer is placed in the rectum
and releases sound waves that bounce off the prostate tissue to
create an image using reflected sound waves
Prostate Biopsy: physician will use a hollow needle to remove a small
piece
of prostate tissue.
Gleason System: after biopsy is taken, a pathologist will grade the
tissue
on a scale of 2-10. 2 being the least aggressive, and 10 being the
most.

Diagnostic Studies
Diagnostic studies are done to determine
if cancer has spread to other parts of the
body
MRI
CT
X-RAY
Bone Scan
ProstaScint (used to check for prostate
cancer cells in the lymph nodes or other
soft tissues)

Diagnostic Studies

Treatment
Treatment depends on Age, stage of tumor,
general health, comorbidities, personal
preference, and risks
Surgery
Cryosurgical ablation
Radiation therapy
Hormone therapy
Brachytherapy
Chemotherapy
Watchful waiting

Surgery
Radical prostatectomy (removes entire
prostate, only in men in good health and no
comorbidities)
Suprapubic prostatectomy
Retropubic prostatectomy
Perineal prostatectomy
TURP (Transurethral resection of the prostate)
Only cancerous portion is removed, not
recommended unless your age or illness
prevents a radical prostatectomy
Nerve sparing prostatectomy (limits risks)

Radiation Therapy
Involves high energy x-rays to shrink
or kill cancer cells
External Beam radiation
Brachytherapy involves placing
radioactive seeds Inside the prostate
gland.
(Can only be used if you have a low
Gleason
score and low PSA level).

Hormone Therapy
Used when cancer is advanced and has
spread to other parts of the body
Decreasing testosterone will inhibit or
shrink the cancer
Orchiectomy: surgical removal of the
testicles to decrease testosterone
LHRH (Luteinizing hormone releasing
hormone): stimulates release of LH
hormone from pituitary to decrease
testosterone
Estrogen: signals the body to stop making

Chemotherapy
Docetaxal (Taxotere): A plant alkaloid that
is given through IV
Depending on stage of cancer, can be
given in pill form or systemically injected

Watchful Waiting
People who are diagnosed with a
non-aggressive form of prostate
cancer may be under careful
observation with no immediate
treatment

Nursing Diagnosis

Impaired Urinary Elimination


Risk for Infection
Risk for Altered Sexuality Patterns
Fear/Anxiety
Self-care deficit
Acute pain
Altered Nutrition: Less than body
requirements

Nursing
Interventions/Teaching

Monitor vital signs


Monitor urine output and urine characteristics
Place patient in left lateral prone, lithotomy, or standing bent prone over
the table for rectal exam
Trans-rectal exam is uncomfortable, but painless and lasts for 20 minutes
In a digital rectal exam you may feel pressure from the gland and a
sensation to urinate. It may be painful if the gland is swollen or irritated
Before surgery and biopsy, stop NSAIDs and aspirin 5-7 days prior
After biopsy, complete full dose of antibiotics, restrict activity for first 24
hours after,
After prostatectomy, avoid lifting objects heavier than 20lbs for at least 6
weeks
Increase fluids
During LH and estrogen therapy, patient may experience hot flashes,
flushing, and impotence
Patient may have tender breasts
Patient is able to orgasm, but is still infertile
Establish voiding schedule
Kegel exercises
Collaborative care: urologist, radiation oncologist, dietitian, physician,

Prevention
According to the American Cancer Society, early detection
and better screening methods has increased the survival
rate for all stages of prostate cancer over the last 30 years
Screening begins at age 40
Annual digital rectal exams

Questions
1.Thenurseisteachingagroupofmenaboutprostatecancer.Whichofthe
followingpointsshouldbeincludedintheinstruction?Selectallthatapply.
1.Prostatecancerisusuallymultifocalandslowgrowing.
2.Mostprostatecancersareadenocarcinoma.
3.TheincidenceofprostatecancerishigherinmenofAfricandescent,
andtheonsetisearlier.
4.Aprostatespecificantigen(PSA)labtestgreaterthan4ng/mgwillneed
tobemonitored.
5.Cancercellsaredetectableintheurine.

Questions
1,2,3,4Canceroftheprostateglandisthesecondleadingcauseofcancer
deathamongAmericanandCanadianmenandisthemostcommon
carcinomainmenolderthanage65.Incidenceofprostatecancerishigher
inmenofAfricandescent,andonsetisearlier.Mostprostatecancersare
adenocarcinoma.Prostatecancerisusuallymultifocal,slowgrowing,and
canspreadbylocalextension,bylymphatics,orthroughthebloodstream.
Prostatespecificantigen(PSA)greaterthan4ng/mgisdiagnostic;afree
PSAlevelcanhelpstratifytheriskofelevatedPSAlevels.Metastatic
workupmayincludeskeletalxray,bonescan,andcomputedtomography
ormagneticresonanceimagingtodetectlocalextension,bone,andlymph
nodeinvolvement.Theurinedoesnothaveprostatecancercells.

Questions
2.Whenaclientisreceivinghormonereplacementforprostatecancer,the
nurseshoulddowhichofthefollowing?Selectallthatapply.
1.Informtheclientthatincreasedlibidoisexpectedwithhormonetherapy.
2.Reassuretheclientthaterectiledysfunctionwillnotoccurasa
consequenceofhormonetherapy.
3.Providetheclienttheopportunitytocommunicateconcernsandneeds.
4.Utilizecommunicationstrategiesthatenabletheclienttogainsome
feelingofcontrol.
5.Suggestthatanappointmentbemadetoseeapsychiatrist.

Questions
3,4.Hormonemanipulationdeprivestumorcellsofandrogensortheir
byproductsand,thereby,alleviatessymptomsandretardsdisease
progression.Complicationsofhormonalmanipulationincludehotflashes,
nauseaandvomiting,gynecomastia,andsexualdysfunction.Aspartof
supportivecare,provideexplanationsofdiagnostictestsandtreatment
optionsandhelptheclientgainsomefeelingofcontroloverhisdisease
anddecisionsrelatedtoit.Tohelpachieveoptimalsexualfunction,give
theclienttheopportunitytocommunicatehisconcernsandsexualneeds.
Informtheclientthatdecreasedlibidoisexpectedafterhormonal
manipulationtherapy,andthatimpotencemayresultfromsomesurgical
proceduresandradiation.Apsychiatristisnotneeded.

Questions
3.Aclientwithprostatecanceristreatedwithaluteinizinghormonereleasing
hormoneagonist.Thenurseshouldinstructtheclienttoexpecttohave:
1.Tendernessofthescrotum.
2.Flushing.
3.Lossofpubichair.
4.Decreasedbloodpressure.

Questions
2.Acommonsideeffectisflushingorhotflashes.Changesinblood
pressure,tendernessofthescrotum,anddramaticchangesinsecondary
sexualcharacteristicsshouldnotoccur.

Questions
4.Thenurseiscaringoraclientwhowillhaveabilateralorchiectomy.The
clientaskswhatisinvolvedwiththisprocedure.Thenursesmostappropriate
responsewouldbe?Thesurgery:
1.Removestheentireprostategland,prostaticcapsule,andseminal
vesicles.
2.Tendstocauseurinaryincontinenceandimpotence.
3.Freezesprostatetissue,killingcells.
4.Resultsinreductionofthemajorcirculatingandrogen,testosterone.

Questions
4.Bilateralorchiectomy(removaloftestes)resultsinreductionofthe
majorcirculatingandrogen,testosterone,asapalliativemeasuretoreduce
symptomsandprogressionofprostatecancer.Aradicalprostatectomy
(removalofentireprostategland,prostaticcapsule,andseminalvesicles)
mayincludepelviclymphadenectomy.Complicationsincludeurinary
incontinence,impotence,andrectalinjurywiththeradicalprostatectomy.
Cryosurgeryfreezesprostatetissue,killingtumorcellswithout
prostatectomy.androgen,testosterone.

Questions
5.Thenurseisperformingadigitalrectalexamination.Whichofthe
followingfindingsisakeysignorprostatecancer?
1.Ahardprostate,localizedordiffuse.
2.Abdominalpain.
3.Aboggy,tenderprostate.
4.Anoninduratedprostate.

Questions
1.Ondigitalrectalexamination,keysignsofprostatecancerareahard
prostate,indurationoftheprostate,andanirregular,hardnodule.
Accompanyingsymptomsofprostatecancercanincludeconstipation,
weightloss,andlymphadenopathy.Abdominalpainusuallydoesnot
accompanyprostatecancer.Aboggy,tenderprostateisfoundwith
infection(eg,acuteorchronicprostatitis).

Questions
6.Aclientisundergoingatotalprostatectomyorprostatecancer.Theclient
asksquestionsabouthissexualfunction.Thebestresponsebythenurseis
whichofthefollowing?Lossoftheprostateglandmeansthat:
1.Youwillbeimpotent.
2.Youwillbeinfertileandtherewillbenoejaculation.Youcanstill
experiencethesensationsoforgasm.
3.Youwillhavenolossofsexualfunctionanddrive.
4.Yourerectilecapabilitywillreturnimmediatelyaftersurgery.

Questions
2.Lossoftheprostateglandinterruptstheflowofsemen,sotherewillbe
noejaculationfluid.Thesensationsoforgasmremainintact.Theclient
needstobeadvisedthatreturnoferectilecapabilityisoftendisruptedafter
surgery,butwithin1year95%ofmenhavereturnedtonormalerectile
functionwithsexualintercourse.

Questions
7.WhichistheAmericanCancerSociety'srecommendationforearly
detectionofprostatecancer?
1.YearlyPSAandDREbeginningatage40.
2.Biannualrectalexambeginningatage50.
3.Semiannualalkalinephosphataselevelbeginningatage45.
4.Yearlyurinalysistodeterminepresenceofprostaticfluid.

Questions
1.YearlyPSAandDREbeginningatage40.Screeningscanhelpfind
cancersatanearlierstagewhentreatmentismoresuccessful.

Questions
8.Thenurseiscaringforaclientwithcanceroftheprostatefollowinga
prostatectomy.Thenurseprovidesdischargeinstructionstotheclientandtells
theclientto:
1.avoiddrivingthecarfor1week
2.restrictfluidintaketopreventincontinence
3.avoidliftingobjectsheavierthan20lbforatleast6weeks
4.notifythephysicianifsmallbloodclotsarenoticedduringurination

Questions
3.avoidliftingobjectsheavierthan20lbforatleast6weeks.Theclient
whohasundergoneaprostatectomyshouldavoidliftingobjectsheavier
than20lbforatleast6weeks.Drivingacarandsittingforlongperiods
arerestrictedforatleast3weeks.Ahighdailyfluidintakeshouldbe
maintainedtolimitclotformationandpreventinfection.Smallpiecesof
tissueorbloodclotsmaybepassedduringurinationforupto2weeksafter
surgery;thisisanexpectedoccurrence.

Questions
9.The80y.o.maleclientisdiagnosedwithprostatecancer.Whichtreatment
wouldthenursediscusswithhim?
1.Radiationtherapyeverydayfor4weeks.
2.Radicalprostatectomywithlymphnodedissection.
3.Diethylstilbestrol(DES),anestrogen,daily.
4.Penileimplantstomaintainsexualfunctioning.

Questions
3.Diethylstilbestrol(DES),anestrogen,daily.Estrogentakendailycan
lowertestosterone.Testosteronecontributestoprostateglandgrowth
whichmakesthecancergrow.

Questions
10.Aclientisdiagnosedwithprostatecancer.Whichtestisusedto
monitorprogressionofthisdisease?
1.Serumcreatinine
2.Completebloodcellcount(CBC)
3.Prostatespecificantigen(PSA)
4.Serumpotassium

Questions
3.Prostatespecificantigen(PSA).PSAhastobemonitoredcloselywhen
patientshaveprostatecancer,anyelevationwouldindicatemetastasizeof
thecancer

Citation

Billings,D.M.,&Hensel,D.(2015).Lippincott'sQ&AreviewforNCLEXRN.
Philadelphia:WoltersKluwer/LippincottWilliams&WilkinsHealth.
Fallon,L.F.,&Oberleitner,M.(2013).ProstateCancer.InB.Narins(Ed.),The
GaleEncyclopediaofNursingandAlliedHealth(3rded.,Vol.5,pp.27742779).
Detroit:Gale.Retrievedfromhttp://go.galegroup.com/ps/i.do?
p=GVRL&sw=w&u=cuny_statenisle&v=2.1&it=r&id=GALE
%7CCX2760400890&sid=exlibris&asid=8bd5ef445914d90564a4dbf823f2129f
Jones,J.(2013).ProstatecancerdiagnosisPSA,biopsyandbeyond(Current
clinicalurology).NewYork:HumanaPress.
Silvestri,LindaAnne.SaundersComprehensiveReviewfortheNCLEXRN
Examination.N.p.:n.p.,n.d.Print.