prostate final

7/31/2019 Prostate Final

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STATISTICS It is the second most common cause of cancer death in males.

Prostate cancer is most common in men age 65 and older, although younger men can bediagnosed with it as well.

By age 80, more than half of all men have some cancer in their prostate.

African American men tend to be diagnosed at younger ages and with faster-growingprostate cancer than men of other races.

PROSTATE CANCEROVERVIEW:

It is a form of cancer that develops in the prostate, a gland in the male reproductivesystem.

It is the most common noncutaneous cancer among males.

Most prostate cancers are slow growing; however, there are cases of aggressive prostatecancers.

Prostate cancer tends to develop in men over the age of fifty.

It is classified as an adenocarcinoma or glandular cancer.

The cancer cells may metastasize from the prostate to other parts of the body, particularlythe bones and lymph nodes.

SIGNS AND SYMPTOMS:

Difficulty in urinating,

Problems during sexual intercourse

Erectile dysfunction- frequent urination

Nocturia

Difficulty starting and maintaining a steady stream of urine

Hematuria

Dysuria

Bone pain Leg weakness

Urinary and fecal incontinence

ANATOMY AND PHYSIOLOGY:

The prostate lies below the bladder and encompasses the prostatic urethra.

It is surrounded by a capsule and is separated from the rectum by a layer offascia termed

as the Denonvilliers aponeurosis

The inferiorvesical artery which is derived from the internal illiac artery, supplies bloodto the base of the bladder and prostate.

The capsular branches of the interior vesical artery help identify the pelvic plexus arising

from the S2-4 and T10-12 nerve roots.

The neurovascular bundle lies on either side of the prostate on the rectum. Itis derived

from the pelvic plexus and is important for erectile function.

PATHOPHYSIOLOGY:

1. When normal semen- secreting prostate gland cells are damaged beyond repair;

instead of being eliminated through the process called apoptosis;


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sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes

form a picture of body tissues called a sonogram. Transrectal ultrasound may be used

during abiopsy procedure.

Biopsy: The removal ofcellsor tissues so they can be viewed under a microscope by a

pathologist. The pathologist will check the biopsy sample to see if there are cancer cells

and find out the Gleason score. The Gleason score ranges from 2-10 and describes howlikely it is that a tumorwill spread. The lower the number, the less likely the tumor is to

spread.

TREATMENT

There are different types of treatment are available for patients withprostate cancer.

1. ACTIVE SURVEILLANCE (watchful waiting): In many patients older than age 70, notreatment may be indicated because the cancer may be slow growing and will not be the cause of

death.Watchful waiting is closely monitoring a patients conditionwithout giving any treatment

until symptoms appear or change. This consists of closely monitoring the patient's prostatecancer by performing the PSA and DRE tests regularly, and treating it only if and when the

prostate cancer causes symptoms or shows signs of growing.

2. SURGERY: Patients in good health and under age 70 is usually offered surgery as a treatment

option. The following types of surgery are used:

Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue,andseminal vesicles. There are 2 types of radical prostatectomy:

o Retropubic prostatectomy, the prostate is removed through an incision in the wall

of the abdomen.o

Perineal prostatectomy, the prostate is removed through an incision in the areabetween the scrotum and the anus.

Laparoscopic surgery: In this type of surgery, the doctor uses a laparoscope to see andremove the prostate. This surgery is done through 4 to 6 small cuts in the navel and the

abdomen, instead of a single long cut in the abdomen. The laparoscope is inserted

through one of the cuts, and surgery tools are inserted through the others.

Transurethral resection of the prostate (TURP): A surgical procedure to remove

tissue from the prostate using aresectoscope inserted through the urethra. This procedure

is sometimes done to relieve symptoms caused by a tumorbefore other cancer treatment

is given. Transurethral resection of the prostate may also be done in men who cannothave a radical prostatectomy because of age or illness.

Radiation therapy: Radiation destroys cancer cells, or prevents them from growing, bydirecting high-energy X-rays (radiation) at the prostate. There are two types of radiationtherapy:

o External radiation therapy: A machine outside the body directs radiation at the

cancer cells.

o Internal radiation therapy (brachytherapy): Radioactive seeds or pellets are

surgically placed into or near the cancer to destroy the cancer cells.
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3. Hormone therapy can play a role in treating early-stage prostate cancer. For men with high-

risk early-stage prostate cancer, it may be used along with radiation therapy. The patient can

receive it instead of surgery or radiation if they are in their 70s or older or have other healthproblems. This treatment uses drugs or other hormones to remove male sex hormones or block

them from working, which prevents cancer cells from growing.

Hormone therapy used in the treatment of prostate cancer may include the following:

Luteinizing hormone-releasing hormone agonists can prevent the testicles from makingtestosterone. Examples are leuprolide, goserelin, andbuserelin.

Antiandrogens can block the action of androgens (hormones that promote male sex

characteristics). Examples areenzalutamide,flutamide, and nilutamide.

Drugs that can prevent the adrenal glands from making androgens include ketoconazole

andaminoglutethimide.

Orchiectomy is a surgical procedure to remove one or both testicles, the main source of

male hormones, to decrease the amount of hormone being made.

Estrogens (hormones that promote female sex characteristics) can prevent the testiclesfrom making testosterone. However, estrogens are seldom used today in the treatment of

prostate cancer because of the risk of serious side effects.

Hormone treatments come in shots or pills. Most of the research about hormonemedicines is on these drugsleuprolide (Lupron, Viadur, Eligard), goserelin

(Zoladex), flutamide (Eulexin), and bicalutamide (Casodex). Hormone medicines are

often combined with prostate surgery or radiation. Hormone treatment can also be usedby itself.

Other therapies used in the treatment of prostate cancer that are still under investigation

include

4. Chemotherapy: It is a combination of drugs which is effective to kill or slow the growth ofrapidly multiplying cells. Chemotherapy is usually prescribed to men with advanced prostate

cancer. Chemotherapy drugs are carefully controlled in both dosage and frequency so that cancer

cells are destroyed while minimizing the risk to healthy cells. As the drugs circulate throughout

the whole body, they can effect the healthy cells also.

5. Cryotherapy/Cryosurgery: (also called cryoablation or cryosurgical ablation) is a type of

treatment that involves freezing the prostate to destroy cancer cells. In this type of treatment, the

doctor delivers liquid nitrogen to the prostate through a special probe. The doctor inserts the

probe into the prostate through an incision between the scrotum and anus. Sometimes, the doctormay also use needles to deliver liquid nitrogen to the prostate. He or she can insert the needles

through the skin without making an incision.

SIDE EFFECTS OF TREATMENT
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All prostate cancer treatments can cause side effects. The most common side effects are sexual,

urinary, and bowel problems. Some of these problems happen soon after treatment and others

develop over time.

Erectile dysfunction (ED) means not being able to keep an erection for intercourse. ED

is the most common long-lasting side effect. It can happen with any treatment. Urinary problems are another long-lasting side effect. This can mean leaking or

dribbling urine. Urinary problems are more common after surgery than with other

treatments.

Bowel problems can also be a long-lasting side effect. This can mean sometimes having"bowel urgency" (needing to have a bowel movement right away and not being able to

wait). Long-lasting bowel problems are more common after external beam radiation or

hormone treatment than after prostate surgery or with watchful waiting.

NURSING MANAGEMENT

Encourage all men to seek medical screening for prostate cancer. Before surgery, discuss the expected results. Explain that radical surgery always produces

impotence. Up to 7% of patients experience urinary incontinence.

To help minimize incontinence, teach the patient how to do perineal exercises while hesits or stands.

If appropriate, discuss the adverse effects of radiation therapy. All patients who receive

pelvic radiation therapy will develop such symptoms as diarrhea, urinary frequency,nocturia, bladder spasms, rectal irritation, and tenesmus.

Provide encourage the patient to express his fears and concerns, including those about

changes in his sexual identity, owing to surgery. Offer reassurance when possible.

Assess pain control. Make sure that the patient is not undermedicated. Give analgesics as

necessary Administer ordered. Teach relaxation techniques such as imagery, music therapy, and progressive muscle

relaxation as adjunct to pain control.

Help achieve optimal sexual function, give the patient the opportunity to communicate

his concerns and sexual needs.

Inform the patient that decreased libido expected after hormonal manipulation therapy,and that impotence may result from some surgical procedures and radiation.

Start sexual counseling, learning other options of sexual expression, and consideration of

penile implant.

Emphasize the importance of follow-up for check of PSA levels and evaluation for

disease progression.

Advise the patient to report symptoms of worsening urethral obstruction, such asincreased frequency, urgency, hesitancy, and urinary retention.

After prostatectomy

Regularly check the dressing, incision, and drainage systems for excessive blood.

Be alert for signs of infection


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Internal radiation of the prostate almost always results in cystitis in the first 2 to 3 weeks

of therapy. Maintain adequate fluid intake (at least 2,000 ml daily).

Give antispasmodics, as ordered, to control postoperative bladder spasms. Also provideanalgesics as needed.

Because urinary incontinence commonly follows prostatectomy, keep the patients skin

clean and dry. Give meticulous three-way catheter catheter care. Check the tubing for kinks, mucus

plugs, and clots, especially if the patient complains of pain.

After transurethral resection - Watch for signs of urethral stricture (dysuria, decreased

force and caliber of urine stream, and straining to urinate). Also observe for abdominal

distention (a result of urethral stricture or catheter blockage by a blood clot). Irrigate thecatheter, as ordered.

After radiation therapy - Watch for the common adverse effects of radiation to the

prostate. These include proctitis, diarrhea, bladder spasms, and urinary frequency.

After hormonal therapy - When a patient receives hormonal therapy with

diethylstilbestrol, watch for adverse effects (gynecomastia, fluid retention, nausea, andvomiting).

prostate final

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