CANCER OF THE PROSTATE
Cancer of the prostate is the 2nd most common cause of cancer [the 2nd most common cause of cancer deaths in American males.
Etiology & Pathophysiology
1. The majority of prostate cancers arise from the peripheral zone of the g therefore, most prostatic cancers are palpable on rectal examination.
2. Prostate cancer can spread by local extension, by lymphatics or by way of bloods stream.
3. The etiology is unknown; there is an increased risk for persons with a far history of the disease.
Clinical manifestations
1. Most early stage prostate cancers are asymptomatic
2. Symptoms due to abstraction of urinary flow
a. Hesitancy and straining on voiding, frequency, nocturia
b. Diminution in size and force of urinary stream.
3. Symptoms due to metastasis
a. Pain in lumbosacral area radiating to hips and down legs [(from be metastasis)]
b. Perineal and rectal discomfort.
c. Anaemia, weight loss, weakness, nausea, oliguria (from urimia)
d. Haematuria (from urethral or bladder invasion, or both).
e. Lower extremity edema occur when pelvic node metastasis compromises venous return.
Diagnostic Evaluation
1. Digital rectal examination [prostate can be felt thro; the wall of the rectum; ha nodule may be felt]
2. Needle biopsy [(thro' anterior rectal wall or thro' perineum)] for histologic study of biopsied tissue.
3. Transacted ultrasonography a sonar probe placed in rectum.
4. PSA [Serologic marker of prostate cancer.
a. Suspicion of prostate cancer if measures 4.0 and 10 ng/ml.
b. Most PSA measurements over 10ng/ml indicate prostate cancer]
C. Staging evaluation skeletal x-rays, CT, or MRI and bone scan, analysis of pelvic lymph nodes provides most accurate staging information. 1
Medical Management
Conservative measures
1. Symptom control
a. Analgesics and narcotics to relieve pain
b. Short course of radio therapy for specific sites of bone pain.
C. IV administration of ẞ- emitter agents (strontium chloride 89) deliver radio therapy directly to sites of metastasis.
d. TURP to remove obstructing tissue of bladder outlet obstruction occurs.
e. Supra public catheter placement]
Surgical intervention (Curative)
1. Radical prostatectomy removal of entire prostate gland, prostates capsule and seminal vesicles; may include pelvic lymphadenectomy.
2. Cryosurgery of the, prostate freezes prostate tissue, killing tumor cells without removing the gland.
Radiation (Curative)
1. External beam radiation focused on the prostate - to deliver maximum radiation dose to tumor and minimal dose to surrounding tissues.
2. Interstitial implantation of radioactive substances (brachy therapy) into prostate, with delivers doses of radiation directly to tumor [while sparing uninvolved tissue]
3. Both forms of radiation are used in some patients; external beam followed by brachy therapy.
Hormonal manipulation (Palliative)
1. Bilateral orchiectomy (removal of testes) results in reduction of the major circulating androgen testosterone. produced by adrenal glands] [A small account of androgen is still
2. Pharmacologic methods [of achieving androgen deprivation also used to reduce tumor volume before surgery or radiation therapy]
a. Luteinizing hormone releasing hormone (LHRH) analogues (Leuprolide (lupron] goserelin acetate (zolodex) reduce testosterone levels as effectively as orchiectomy.
b. Antiandrogen drugs (flutamide Eulexin) bicalutamide [casodex] nilutamide [Nilaudron]) block androgen action directly at the target tissues [(testes and adrenals)] and 1-lock androgen synthesis within the prostate gland.
c. Complications of therapy with LHRH analogues and an anti androgen blocks the action of all circulating androgen.
Complications
1. Bone metastasis [vertebral collapse and spinal cord compression, pathologic fractures]
2. Complications of treatment [radiation therapy cystitis, urethral injury, * radiation enteritis, radiation proctitis, impotence.
3. Surgery urinary incontinence, impotence and rectal injury.
4. Hormonal hot flashes, nausea and vomiting, gynecomastia, sexual dysfunction]
Nursing interventions
1. Give repeated explanations of diagnostic tests and treatment option; help gain some feeling of control over disease and decision.
2. Let patient know that decreased libido is expected after hormonal manipulation therapy and impotence may result from some surgical procedures and radiation. 1
3. Suggest options such as sexual counselling, bearing other methods of sexual expression and consideration of pharmacologic options for treatment of erectile dysfunction.
4. Administer and teach self-administration of narcotic analgesics as ordered.
5. Teach relaxation, technique such as imagery, music therapy, progressive muscle relaxation.
6. Teach patient importance of follow evaluation for disease progression. up for check of PSA levels and
7. If bone metastasis has occurred, encourage safety measures [around the house] to prevent pathologic fractures [such as removal of throw rugs, using hand rail on stairs, using night lights.]
8. Advise reporting of symptoms of worsening urethral obstruction such as increased frequency, urgency, hesitancy and urinary retention.
