CANCER OF THE PROSTATE

Prostate Cancer (is the most common cancer among men) twice as higher
in African American men than in Caucasians.

Risk factors
>increasing age after 50-65 years old

>Hereditary

>person take food high in red meat & fats

Clinical manifestations

s/sx if is large enough to encroach on the bladder neck:

>Difficulty and frequency of urination, urinary retention,

decrease size and force of the urinary stream, Blood in the urine or semen,
painful ejaculation.

s/sx if cancer metastases to bone & lymph nodes:

>backache, hip pain, perineal & rectal discomfort, anemia, wt.

loss, nausea, weakness and oliguria ( decrease urine output )
> Rare sx: Azotemia ( nitrogen compounds in blood )

" The symptoms that develop from Urinary obstruction occur in late in
the disease"

Assessment and Diagnostic Findings

* Digital Rectal Examination ( DRE )

* Rectal Palpation of gland - for nodule within the subs. of gland

The dx of prostate cancer is confirmed by histologic examination of

tissue removed surgically by:

* Transurethral resection

* Open Prostatectomy
 * Transectal needle biopsy

* Fine needle aspiration - obtaining prostate cells for cytologic

examination & determining the stage of the disease as well.

* Simple blood test - measures PSA levels

* PSA testing is monitored routinely to identify the pt's response for

cancer therapy, & also detects local progression & early recurrence of prostate
cancer
* Transcretal ultrasound (TRUS) - detects nonpalpable prostate
cancer.
* Bone scan - detect metastatic bone dse.

* Skeletal x-ray - identify bone metastases.

> Radiolabeled monoclomal antibody capromab Pendetide with Indium-111

( ProstaScint ) -
-Antibody that is attracted to the prostate-specific membrane antigen
found on prostate cancer cells.
> PSA - a neutral serine protease produced by the normal & neoplastic
ductal epithelium of the prostate and secreted into the glandular lumen.

Sexual Complication
Men with prostate cancer commonly experienced sexual
dysfunction before the dx is made.

> Sildenafil ( Viagra ) effective for treating erectile dysfunction.

Medical Management

>Tx is based on the stage of the dse,age & symptoms.

> Nomogram is done to predict the pathologic stage of localized
prostate cancer

Surgical Management
> Radical prostatectomy ( removal of the prostate & seminal vesicles )

Radiation Therapy( For early stage of detection)

> Teletherapy with a Linear accelerator or Interstitial irradiation-

( implantation of radioactive seeds of Iodine or Palladium ) also referred to as
Brachytherapy
> Teletherapy- 6 to 7 wks of daily ( 5 days/weeks )radiation treatments.
 > Interstitial seed implantation- is performed under anesthesia.
( 80 to 100 seeds ) guided with
ultrasound.
Side effects:

> proctitis, enteritis and cystitis

> irritation of bladder & urethra can cause pain in urination and
ejaculation

Hormonal Therapy
> one method use to control rather than cure by Androgen withrawal
It suppresses the androgenic stimuli by decreasing the circulating
plasma testosterone levels or binding of dihydrotestosterone.

* Orchiectomy
*Estogen Therapy

> Newer hormonal Therapies

* ( LH - RH ) leutenizing hormone releasing homone

* Cyproterone Acetate

> Other Therapies

* Cryosurgery of the prostate- used to ablate prostate cancer in pt
who could not physically tolerate surgery or in those with recurrent prostate
cancer.
* Chemotherapy- suhc as doxurubicin, cisplatin, &
cyclophosphamide.Opoids and non opiods are used to control the pain.

*External beam radiation therapy- can be delivered to skeletal lesions to relieve

pain.

*Radiopharmaceuticals such as Strontium 89 and Samarium 153 is intravenously

injected to treat multiple sites of bone metastases.

*Prednisone and Mitoxantrone have been effective in controlling pain.

The Patient Undergoing Prostate Surgery

Surgical Procedures

TURP-Transurethral Resection of the Prostate--> the most common procedure

used can be carried out through endoscopy. The surgical and optical instrument
introduced directly through the urethra to the prostate, which can be viewed
directly. The gland is removed in small chips with an electrical cutting loop. It
may require no incision, may be used for glands of varying size and is ideal for
patients who have small glands and those who are considered poor surgical
risks.

Suprapubic Prostatectomy-->is one of the method the through an abdominal

incision.

Perineal Prostactectomy-->involves removing the gland through an incision in the

perineum.

Retropubic Prostactectomy--> it makes a low abdominal incision and approaches

the prostate gland between the pubic arch and the bladder without entering the
bladder.

Transurethral Incision of the Prostate--> An instrument passed through the

urethra. One or two incisions are made in the prostate and prostate capsule to
reduce the prostate's pressure on the urethra and to reduce the urethral
\constriction.

Laparoscopic Radical Prostactectomy--> more used in extensive surgery in

patients with localized prostate cancer.

COMPLICATIONS:

HEMORRHAGE
CLOT FORMATION CATHETER OBSTRUCTION
IMPOTENCE-potential damage to pudendal nerves

VASECTOMY may be performed surgery to prevent infection.

PREOPERATIVE NURSING INTERVENTIONS:

1.) Reducing Anxiety- nurse must establish communication with the patient to
assess his understanding of the diagnosis and of the planned surgical
procedure. Privacy and trust relationship.
2.) Relieving Discomfort--> the patient is placed on bed rest analgesic agents
are administered. The nurse must monitor the patient's voiding pattern,
watches for bladder distention and assist with catheterization.
3.) Providing Instruction--> the nurse reviews the anatomy and physiology of
the affected part and the function in relation the urinary and reproductive
system using diagrams and teaching aids if indicated.
 4.) Preparing the Patient--> Elastic Compression Stockings before surgery be
applied for prevention of deep vein thrombosis. An enema is administered
at home the evening before surgery.

POSTOPERATIVE PROCEDURE

1.) Maintaining Fluid Balance - the urine output must be closely monitored.

2.) Relieving Pain-->meds include flavoxate and oxybutynin. Warm

compresses to the pubis or sitz bath may also relieve the spasms. The
nurse monitors the drainage tubings and irrigate the system as prescribed
to relive any obstruction that may cause discomfort. Prune juice and stool
softeners are provided to ease bowel movements and to prevent excessive
straining.

COMPLICATIONS:
-->Hemorrhage
-->Infection
-->Deep Vein Thrombosis
-->Obstructed Catheter