Prostate Cancer

Prostate Cancer

Prostate Cancer

Cancer that forms in

tissues of the prostate

Prostate Cancer

Etiology/Risk factors

Prostate Cancer

Genetics Gene alterations on chromosome 1, 17, and the X

chromosome Race Prostate cancer is the most common type of cancer

found in American men, other than non melanoma skin cancer.Although men of any age can get prostate cancer, it is found most often in men over age 50. In fact, more than 8 of 10 men with prostate cancer are over the age of 65.

Diet Men who are obese and eat a diet high in fat are

also at a higher risk for prostate cancer. A high-fat diet may lead to increased risks, while a diet rich in soy may be protective 

Hormonal

Prostate Cancer

Clinical Signs and

Symptoms

Prostate Cancer

 Symptoms of urinary obstructions Pain with ejaculation Hip and lower back pain that does

not go away over time Pain in the lower part of your pelvis Unintended weight loss and/or loss of

appetite

Prostate Cancer

PC can metastasized to bone and lymph nodes

s/s of metastases: Backache, Hip pain Perineal and rectal discomfort Anemia, nausea Weight loss, weakness Oliguria

Prostate Cancer

Normal Anatomy and Comparison

Prostate Cancer

Pathophysiology

Prostate Cancer

Predisposing and precipitating factors 

Develops the rates of cell division and cell death are no longer equal, leading to uncontrolled tumor growth.

Transitional cell morphology and are thought to arise from the urothelial lining of the prostatic urethra

 70% arise in the peripheral zone, 15-20% arise in the central zone, and

10-15% arise in the transitional zone.  

They become multifocal, with synchronous involvement of multiple zones of the prostate, which may be due to clonal and nonclonal

tumors.

Prostate Cancer

Primary tumor, that cannot be assessed clinically tumor not palpable or viosible by imaging

Tumor incidental histologic finding in less than or equal to 5% of tissue resected

Tumor confined within prostate,nvolving less than half a lobe

Tumor involving less than or equal to 1 lobe

 Tumor involving both lobes extending through the prostatic capsule; no

invasion into the prostatic apex or into, but not beyond, the prostatic capsule

Prostate Cancer

Tumor invading seminal vesicle(s)

Tumor fixed or invading adjacent structures other than seminal vesicles (eg, bladder neck, external sphincter, rectum, levator muscles, pelvic

wall)

Prostate Cancer

Stages of

Prostate Cancer

Prostate Cancer Prostate Cancer Stage I In stage I, prostate cancer is found in the prostate only.

Stage I prostate cancer is microscopic; it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.

Prostate Cancer Stage II In stage II, the tumor has grown inside the prostate but

hasn’t extended beyond it. Prostate Cancer Stage III Stage III prostate cancer has spread outside the

prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.

Prostate Cancer Stage IV In stage IV, the cancer has spread (metastasized)

outside the prostate to other tissues. Stage IV prostate cancer commonly spreads to lymph nodes, the bones, liver, or lungs.

Prostate Cancer

Assessment and

Diagnostic Study

Abnormal finding of DRE, Serum PSA or TRUS with Biopsy

Digital Rectal Exam

Serum PSA

Prostate Cancer

Routine repeated rectal palpation of the gland

Histologic examination of tissue removed surgically by TUR

Open prostatectomy

Prostate Cancer

Transrectal Needle Biopsy

Prostate Cancer

Fine needle aspiration Radio labeled monoclonal anti

body capromab pendetide with indium 111 (ProstaScint)

Anti body that is attracted to the prostate specific membrane antigen found on prostate cancer cells.

Prostate Cancer

Possible Complications

Prostate Cancer

Sexual dysfunction (DOC PDE-5 inhibitors)

Hormonal therapy also affects the CNS mechanisms that mediate sexual desire and arousability

Prostate Cancer

Medical / Surgical

Management

Prostate Cancer

Treatment are based on stage of disease, patients age and symptoms.

Radical Prostatectomy

Laparoscopic Radical Prostatectomy

Prostate Cancer

Radiation Therapy

Prostate Cancer

Teletherapy (external beam radiation therapy)

Intensity modulated radiation therapy

Prostate Cancer

Hormonal Therapy

Prostate Cancer

Androgen Withdrawal

Prostate Cancer

Brachytherapy

Prostate Cancer

Nursing Diagnosis

and Interventions

Prostate Cancer

Urinary retention r/t urethral obstruction secondary to prostatic tumor

Improve pattern of urinary elimination Determine patients usual pattern of

urinary function Assess for s/s of urinary retention, amt

and frequency of urination, supraspubic distention, complaints of urgency and discomfort

Catheterized to determine amount of residual urine

Prostate Cancer

Deficient knowledge r/t diagnosis of cancer, urinary difficulties and treatment modalities

Initiate measures to treat retention Encourage assuming normal position for

voiding Recommend using valsalva maneuver

preoperatively Consult physician regarding intermittent or

indwelling catheterization Monitor catheter function Prepare patients for surgery if indicated

Prostate Cancer

Maintain Optimal Nutritional Status:

Assess the amt. of food eaten Routinely weight the pt. Recognize effect of medication or

radiation therapy on appetite Inform pt. that alterations in taste can

occur Use measures to control N/V Provide small frequent meals,

comfortable and pleasant environment

Prostate Cancer

Ability to Resume/ Enjoy Modified SexualFunctioning:

Inform patient of the effect of surgery and such therapy

Include partner ion developing understanding and discovering alternative, satisfying close relations with each other

Prostate Cancer

Relief of Pain:

Evaluate pt.’s pain, its location, intensity using pain rating scale

Instruct to avoid activities that aggravate or worsen pain

Because the pain is can be r/t bone metastases, ensure that pt.’s bed has a bed board on a firm mattress, also protect the pt. from falls and injuries

Provide support for affected extremities Prepare pt. for radiation therapy Administer analgesics or opiods ate regularly

scheduled intervals Initiate vowel program to prevent constipation

Prostate Cancer

Improved Physical Mobility:

Assess for factors causing immobility ( pain, hypercalcemia, limited exercise intolerance)

Provide medication for pain relief Assess nutritional status Monitor for collaborative problems

such as, hemorrhage, infection, bladder neck obstruction

Prostate Cancer

Other Therapies

Cryosurgery of the Prostate

Prostate Cancer

Chemotherapy

Using Agents:

Doxorubicin Cisplatin cyclophosphamide

Transurethral Resection of the Prostate

Prostate Cancer

Other Types of

Prostatectomy

Suprapubic Prostatectomy

Perineal Prostatectomy

“ the beginning of knowledge is in the discovery of something we don’t understand”

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