Prostate Cancer

PROSTATE CANCER
Copyright © 2012 Wild Iris Medical Education, Inc. All Rights Reserved.
By Michael Jay Katz, MD, PhD
Judith Swan, MSN, RN

Prostate cancer is the most common non–skin cancer and represents 25% of all estimated new
cancers in American men. In the United States, about 1 man in 6 will be diagnosed with prostate
cancer during his lifetime. Prostate cancer occurs mainly in older men, with almost two thirds
diagnosed at age 65 or older. It rarely occurs before age 40, with the average age at the time of
diagnosis being 68. Many cases of prostate cancer go unrecognized, and it is estimated that 1 in 3
men older than 50 years have prostate cancer that is currently unsuspected. There are more than 2.5
million men in the United States who have been diagnosed with prostate cancer at some point in the
past and who are still alive today (ACS, 2012).

According to the American Cancer Society, most prostate cancers are discovered by noninvasive
screening, a combination of a blood test for the enzyme prostate-specific antigen (PSA), and a digital
rectal examination (DRE). Various diagnostic tools are used for determining the presence of prostate
cancer, including transrectal ultrasound, radionuclide bone scan, CT, MRI, and prostate biopsy. Most
of the detected tumors grow slowly and do not cause death. On the other hand, some tumors are
aggressive, metastasize to bone, and eventually prove fatal.

Prostate cancer arises in the genital area, threatening that part of the body concerned with sexual
function and body waste. When the diagnosis of prostate cancer is made, it has a profound impact on
both the patient and his significant others.

Because the prostate is close to several vital structures, prostate cancer and its treatment strategies
can disrupt normal bladder, bowel, and sexual functioning. Prostate biopsies raise the risk of
hospitalization in many men due to infections and flare-ups of heart failure and pneumonia. Permanent
urinary incontinence and impotence may be the result of the disease and/or treatment.

Early treatment is usually successful. Treating prostate cancer when it is small and confined inside the
prostate can often cure the disease. The following treatments for prostate cancer are used one at a
time or in some cases may be combined:



Watchful waiting or active surveillance



Surgery



Radiation therapy



Cryosurgery



Hormone therapy



Chemotherapy



Biological therapy

Healthcare providers are critical in the management of prostate cancer throughout the disease
continuum. Education and emotional support to the patient, his partner, and family are vital from
screening to diagnosis. Physical and emotional care is required from diagnosis to cure, or from
palliative care to hospice care. Nursing plays a vital role in helping maintain the highest possible
quality of life for each patient.

RISK FACTORS
Because the detailed progression from initial trigger to clinical disease appears to involve a varying
number of factors, the potential contributing agents are often called risk factors rather than causes. For
some of these factors, the link to prostate cancer is not yet clear.

Age
The older a man is, the higher the chance of being diagnosed with prostate cancer. Only 1 in 10,000
men under age 40 will be diagnosed with the disease. However, the rate increases to 1 in 38 for ages
40 to 59, and 1 in 15 for ages 60 to 69. After that age, the chance of developing prostate cancer is
more common than any other cancer in both men and women (Prostate Cancer Foundation, 2012).

Race
African American men are 60% more likely to develop prostate cancer compared to Caucasian men,
are more likely to be diagnosed at an advanced state, and are nearly 1.5 times as likely to die from
prostate cancer (Prostate Cancer Foundation, 2012).

Family History and Genetics
A man who has a father or brother with prostate cancer has double the risk of developing the disease.
The risk is higher for men who have a brother with the disease than for those with an affected father.
This risk is increased further if the cancer occurred at a younger age or if it affected three or more
family members.

About 15% of cases of prostate cancer are governed by strong prostate genes. These are called
familial or hereditary prostate cancers. The remaining 85% of prostate cancers are called sporadic
because they occur in patients whose families show no clustering of cancer cases and in which
prostate cancers usually develop later, in men aged 70 years and older.

Environmental Factors
Many outside influences have been linked to prostate cancer. Even in men with a genetic susceptibility
to prostate cancer, certain environmental factors seem to play a role in causing the cancers to become
clinically apparent.

TNM STAGING SYSTEM FOR PROSTATE C ANCERS
Source: Epstein, 2012.

Tumor (T)

T0

No evidence of primary tumor

T1

Nonpalpable tumor that is not evident from radiographic imaging

T2

Palpable tumor confined to the prostate

T3

Palpable tumor extending beyond the prostate

T4

Palpable tumor that is fixed or that invades adjacent structures

Lymph Nodes (N)

N0

No lymph node metastases

N1

Metastases in one regional lymph node that is ≤2 cm wide

N2

Metastases in one or more regional lymph nodes, each ≤5 cm wide

N3

Metastases in at least one regional lymph node >5 cm wide

Distant Metastases (M)

M0

No evidence of distant metastases

M1

At least one distant metastasis

CARING FOR THE PATIENT UNDERGOING SURGERY
During the preoperative period, patients and their partners and family have a need for information that
will enable them to make informed decisions regarding treatment. The time between diagnosis of
prostate cancer and surgery is a very stressful time. It is important that nurses recognize the influence
of stress on hearing and learning.
It is important to assess a patient’s values before surgery. Once this is completed, information on the
risks and benefits of various treatment options can be presented in light of the patient’s values. The
nurse is able to take the necessary time to provide detailed explanations to patients and their partners
and families. Patients need to be given written information on surgery and potential treatment effects to
assist them in decision-making.

Preoperative interventions for patients who are admitted for prostate surgery include:



Reduce anxiety. Clarify expected outcomes and allow verbalization of feelings.



Relieve discomfort if present preoperatively. Offer pain relief measures, assist with voiding.
Insert catheter if ordered.



Provide instruction regarding anatomy, surgical procedure, and postoperative expectations.



Prepare the patient for surgery. This may include application of antiembolic stockings,
administering an enema, and prophylactic antibiotics.

Intraoperatively, the nurse’s role and responsibilities include the following:



Act as a patient advocate.



Prioritize the needs of patients undergoing the surgical procedure.



Keep a watchful eye on aseptic techniques and procedures to create a secure environment
that will promote wound healing, recovery, and well-being.



Apply principles of sterile technique.



Ensure the presence of a safe environment in the OR.

Postoperatively, the role of the nurse is to:



Maintain fluid balance and document intake and output, including fluid used to irrigate the
catheter.



Assess for electrolyte imbalance.



Monitor vital signs.



Observe for signs of confusion or respiratory distress.



Relieve pain.



Increase mobility.



Assess for bladder spasms.



Monitor wound drainage and provide wound care as ordered.



Provide meticulous catheter and tube care.



Offer prune juice and stool softeners to avoid constipation and straining.



Provide reassurance and explanations of care to patient and significant others.



Maintain nutritional status.



Observe for potential complications, including:

o Hemorrhage
o Infection
o DVT
o Pulmonary embolism
o Catheter obstruction
o Emotional distress and/or depression


Assess for emotional or psychological problems in patient, partner, and family.



Educate patient and significant others regarding discharge and self-care.

PREVENTION
Prostate cancer is a disease of older men, and it appears that the disease typically takes decades to
develop. There are many things that men can do, however, to reduce or delay the risk of developing
prostate cancer.

Both the Prostate Cancer Foundation (2012) and the American Cancer Society (2012) report that they
believe the major risk factor is diet (i.e., foods that produce oxidative damage to DNA). Their
prevention recommendations include:



Eat fewer calories.



Exercise more to maintain a healthy weight.



Reduce red meat and dairy consumption.



Do not take supplemental doses of calcium above the recommended daily allowance of
1,500 mg per day.



Eat more fish.



Avoid trans fatty acids such as found in margarine.



Incorporate cooked tomatoes, olive oil, and cruciferous vegetables into the diet.



Consume soy and green tea, which may also be helpful.



Avoid smoking and use alcohol in moderation, if at all.



Avoid over-supplementation with megavitamins (too much folate may affect the growth of
cancer).



Obtain a yearly rectal examination and PSA testing as recommended by a physician.

SIGN AND SYMPTOMS OF PROSTATE CANCER
There are no warning signs or symptoms of early prostate cancer, and not everyone experiences
symptoms of prostate cancer. Most adenocarcinomas develop in the peripheral zone of the prostate,
where they initially cause no symptoms. Today, because of DRE and PSA screening, greater than
80% of prostate cancers are detected in the asymptomatic stages. Many times, signs of prostate
cancer are first detected by a doctor during routine check-up.

Once a malignant tumor causes the prostate gland to swell significantly, or once cancer spreads
beyond the prostate, symptoms may occur. They include:



A frequent need to urinate, especially at night



Difficulty starting or stopping a stream of urine



A weak or interrupted urinary stream



Inability to empty the bladder completely



Inability to urinate standing up



A painful or burning sensation during urination or ejaculation



Blood in the urine or semen

Depending on the situation, the treatment options for men
with prostate cancer may include:

o
o
o
o
o
o
o
o

Expectant management (watchful waiting) or active surveillance.
Surgery.
Radiation therapy.
Cryosurgery (cryotherapy)
Hormone therapy.
Chemotherapy.
Vaccine treatment.
Bone directed treatment.

SUMMARY:
Prostate cancer is a disease of elderly men. In the United States, it is estimated that more than 1 man
in 6 will be diagnosed with prostate cancer during his lifetime. When the diagnosis of prostate cancer is
made, it has a profound impact on both the patient and his significant others.

Most prostate cancers are discovered by noninvasive screening using DRE and PSA levels. Early
stages of prostate cancer usually produce no symptoms. On the other hand, late stages of prostate
cancer can present with pelvic pain, urinary obstruction, or bone pain. The definitive diagnosis is made
from a biopsy, and the cancers are categorized by grade and stage.

Surgical resection of a prostate tumor can potentially cure the disease when the cancer is still confined
inside the prostate. Surgical resection is called radical prostatectomy, and it includes removal of
nearby lymph nodes. Nerve-sparing radical prostatectomies attempt to preserve the adjacent nerve
bundles that are necessary for sexual functioning.

Radiation therapy is another treatment that can cure or significantly slow the growth of localized
prostate cancers. Radiation can be delivered to the prostate from an external beam focused through
surrounding tissues or radioactive seeds implanted inside the prostate.
Treatments that interfere with a prostate tumor’s supply of androgen (androgen-deprivation therapy)
will slow tumor growth and reduce any symptoms. After a time, however, prostate cancers become
less sensitive to androgen-deprivation treatments, and the tumors resume their growth.

SAINT GABRIEL COLLEGE
KALIBO, AKLAN
IN PARTIAL FULFILMENT
IN
COMPETENCY APPRAISAL II
(JOURNAL / ARTICLE READING)

SUBMITTED TO:
MR. HARLEY DELA CRUZ RN, MAN
INSTRUCTOR

SUBMITTED BY:
KENJE T. TARUSAN
BSN-IV