Cancer Of The Prostate

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