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  

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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

Pathophysiolog y

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

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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

Brachythera py

Prostate

Cancer

Nursing Diagnosis and Interventions

Prostate

Cancer

 Urinary retention r/t urethral

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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

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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

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 Sexual Functioning:  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  

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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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