CANCER OF

PROSTATE GLAND
SUBMITTED TO: SUBMITTED BY:
DR. SHOBHA GUSAIN ANCY ANN OOMMAN
(4 TH SEMESTER, 2ND YE AR)
INTRODUCTION
■ A man's prostate produces the
seminal fluid that nourishes and
transports sperm.

■ Prostate cancer is the most common

cancer and the second leading cause
of cancer death among men
 ANATOMY AND PHYSIOLOGY
OF PROSTATE GLAND
■ Located below the bladder and in front of the
rectum, and surrounds the top of the urethra.

■ Made of glandular and connective tissues,

and is covered by the prostatic fascia.

■ Pyramid-shaped organ or walnut shaped

■ The prostate is a gland in the male

reproductive system that produces fluid that
nourishes and transports sperm. This alkaline
solution protects sperm in the vagina's acidic
environment.
HISTOLOGICAL DIVISION OF
PROSTATE

■ There are four major zones

within the normal prostate:
the peripheral zone (70% of
glandular tissue), the central
zone (20% of glandular
tissue), the transition zone
(5% of glandular tissue), and
the anterior fibromuscular
stroma
 ETIOLOGICAL FACTORS
■ The exact cause of prostate cancer is unknown, but many factors can increase your
risk of developing the disease. These include:
• AGE
• FAMILY HISTORY AND GENETIC PREDISPOSITION
• ETHNICITY
• SMOKING AND ALCOHOL
• OBESITY AND METABOLIC SYNDROME
• PHYSICAL ACTIVITY, DIET, AND NUTRITION
• MEDICATIONS
• SEX AND VASECTOMY
• HORMONES
• INFECTION, INFLAMMATION AND CHEMOKINES
Pathophysiology
Most prostate tumors begin in the peripheral zone------
---cells begin to grow out of control--------- form prostatic
intraepithelial neoplasia (PIN)---- Some PINs continue
to grow, forming layers of tissue that stop expressing
genes common to their original tissue location – p63,
cytokeratin 5, and cytokeratin 14 – and instead begin
expressing genes typical of cells in the innermost
lining of the pancreatic duct – cytokeratin 8 and
cytokeratin 18.--------------These multilayered PINs
overexpress the gene AMACR, which is associated
with prostate cancer progression---------Some PINs can
eventually grow into tumors-------This is commonly
accompanied by large-scale changes to the genome,
with chromosome sequences being rearranged or
copied repeatedly.
SIGN AND SYMPTOMS
■ Prostate cancer symptoms vary from person to person and may not
appear in its early stages. Most men don't have any symptoms. Some
early symptoms include:
• Difficulty starting urination
• Weak or interrupted urine flow
• Frequent urination, especially at night
• Pain or burning during urination
• Blood in the urine or semen
• Dull pain in the lower pelvic zone
• Painful ejaculation
■ More advanced symptoms include:
• Trouble getting an erection (erectile dysfunction or ED)
• Pain in the hips, back (spine), chest (ribs), or other areas
• Weakness or numbness in the legs or feet
• Loss of bladder or bowel control
• Bone pain
• Unexpected loss of weight
• Persistent exhaustion

 Other symptoms include:

• Pain in the back, hips, or pelvis that doesn't go away
• Frequent pain or stiffness in the lower back, hips, or upper thighs
• Swelling in the lower extremities
DIAGNOSTIC EVALUATION
 HISTORY TAKING
A patient's history of prostate cancer may include
family history. For example, if a patient's brother has
recently been diagnosed with prostate cancer, the
patient may also have a family history.

 DIGITAL RECTAL EXAMINATION

A digital rectal exam, or DRE, is a medical test that
checks for abnormalities in rectum, anus and prostate
gland.
DIAGNOSTIC EVALUATION CONTD…
■ PSA TESTS
Prostate-specific antigen (PSA) is a protein
produced by the prostate that can indicate the
presence of prostate cancer. The PSA test
measures the level of PSA in the blood, and is
the standard for prostate cancer screening.

■ PSMA-PET SCAN
PSMA PET scan, or prostate-specific
membrane antigen positron emission
tomography scan, is a non-invasive
imaging procedure that uses a
radioactive substance to help detect
prostate cancer cells.
DIAGNOSTIC EVALUATION CONTD…
■ TRANSRECTAL ULTRASOUND
A transrectal ultrasound (TRUS) is a procedure
that uses high-energy sound waves to create a
video image of the prostate gland and nearby
structures. It's also called an endorectal
ultrasound (ERUS) or prostate sonogram.

 TRANSRECTAL MRI
A transrectal MRI (MRI) is a type of fusion imaging
that combines MRI information with transrectal
ultrasound (TRUS) images for prostate biopsies.
DIAGNOSTIC EVALUATION CONTD…
■ BIOPSY
A prostate biopsy is a procedure that
involves removing small tissue samples
from the prostate gland to examine for
signs of prostate cancer. It's usually
performed when the results of a PSA
blood test are high.
TREATMENT
■ Watchful waiting or active surveillance: Observation
■ Surgery
■ Radiation therapy and radiopharmaceutical therapy
■ Hormone therapy
■ Chemotherapy
■ Targeted therapy
■ Immunotherapy
■ Bisphosphonate therapy
 SURGERY
■ Radical prostatectomy
The main type of surgery for prostate cancer Robotic versus open radical
is a radical prostatectomy. In this operation, prostatectomy:
the surgeon (urologist) removes the entire • Less blood loss during the
prostate gland plus some of the tissue operation
around it, including the seminal vesicles. • Less pain after the operation
Sometimes nearby lymph nodes are • A shorter hospital stay
removed as well. • A quicker recovery time
 Open prostatectomy • Less time the urinary catheter
needs to stay in place
 Laparoscopic radical prostatectomy • A lower risk of some rare but
 Robotic prostatectomy potentially serious side effects
SURGERY CONTD…
A radical prostatectomy is a major surgery
that can cause complications both during
and after the operation. Some common
complications include:
■ Urinary incontinence: Involuntary  Bleeding
leaking of urine that can improve over  Rectal injury
time  Ureteral injury
■ Erectile dysfunction: Also known as  Thromboembolic events
impotence, this is a common side effect  Narrowing of the urethra or bladder
neck
■ Dry orgasm: An orgasm without
ejaculation  Formation of cysts containing lymph
(lymphocele)
■ Infertility: All men experience infertility  Reactions to anesthesia
after the surgery
 Blood clots in the legs or lungs
■ Climacturia: Urine leakage during  Damage to nearby organs
orgasm  Infections at the surgery site
SURGERY CONTD…
■ PELVIC LYMPHADENECTOMY
Pelvic lymphadenectomy remains the criterion
standard for detecting metastatic spread to the
pelvic lymph nodes. The indications for staging
pelvic lymphadenectomy before prostatectomy
include the following:
• Pre-biopsy serum prostate-specific antigen (PSA)
level greater than 20 ng/Ml
• Palpably advanced local disease, clinical stages
T3 and T4
• Positive seminal vesicle biopsy
• Enlargement of pelvic lymph nodes as evident on
pelvic imaging
SURGERY CONTD…
■ TRANSURETHRAL RESECTION OF THE PROSTATE
Transurethral resection of the prostate (TURP), also known as a "rebore", is a
minimally invasive urological surgery that removes tissue from the prostate
through the urethra. TURP is most often done to relieve symptoms caused by an
enlarged prostate. This is often due to benign prostate hyperplasia (BPH).
STAGES OF PROSTATE CANCER
■ Stage I of prostate cancer
Cancer is loculated and hasn’t spread
outside of the prostate gland, it can’t be
felt during the physical examination, PSA
levels are below 10ng/ml and the cells
are still very similar to the original
prostate cells and their growth rate is
slow. Treatment is mostly surgical. Five-
year survival rate is 100%.

■ Stage II of prostate cancer

The tumor is still only in the prostate but
could be felt during the physical
examination, PSA levels are above
10ng/ml, but the cells are still well
differentiated. Treatment is surgical and
radiation and hormone therapy are added
to prevent its return.
STAGES OF PROSTATE CANCER
■ Stage III of prostate cancer
In this stage the cells are no longer well differentiated and grow
outside the prostate gland. Doctors treat stage III with surgery “a
radical prostatectomy”, hormone therapy or radiation therapy. The
rate of recurrence at this stage is large, and doctors’ advice patients
to adhere to repeated examinations for early diagnosis and
effectively target cancer cells if they appear again.

■ Stage IV of prostate cancer

The cancer has spread to lymph nodes or other parts of
the body treatment is usually by hormone therapy
(systemic) or a combination of it alongside chemo and
radiation therapy rarely surgery. Five-year survival rate is
29% and a continuous follow-up and monitoring plan
should be set up.
NURSING MANAGEMENT
■ History taking: during history taking session make e sur e to include e family history urodynamic indicators and
habits, dietary attributes, sexual habits and residence and working environment of the patient
■ Physical assessment: normal physical examination and DR protocols,
■ surgery:
 .pre-operative:
• health education, philological counselling , provide complete information to family members and partner
• Ask patient to eat very light meals and stay hydrated, in the evening before surgery try to stay on a clear
liquid diet
 post- operative: observe for any complications of the performed surgical procedure
• Counsel the patient about resuming of sexual activity
• After prostectomy the risk of impotence is high, monitor for the same
• Observe for infection of surgical site
• Observe for triggering of erectile dysfunction or retrograde ejaculation
• Patients at high risk for developing inguinal hernia
• Council the patient for limiting heavy weight lifting
• foods to avoid after prostate surgery Red meat., Fried foods, Full-fat dairy products
• Prepare a diet chart including frequent light and soft foods
NURSING MANAGEMENT CONTD…
• Ask the patient to lie straight on their back.
• Ask the patient to abstain from alcohol for several weeks to avoid irritating
the bladder
• Educate the patient about their first bowel movement after prostectomy
(third day)
• Radiation therapy :Council the patient about the importance and urinary
problems it may cause and can get worse with age
• Hormone therapy: Council the patient about hot flashes, impaired sexual
function ,loss of desire for sex and weekend bones may occur. Other Side
Effects are diarrhea, nausea and itching
• Bone pain due to metastasis: with the prescription of doctor provide right
dosage of pain medications and corticosteroids from the right route
• Encourage patients for follow up test to find out the recurrence or
effectiveness of the current therapy on the cancer
CONCLUSION
Prostate cancer is a condition that occurs when cells in the prostate
gland grow out of control. The prostate is a gland in the male
reproductive system that produces some of the fluid in semen. Prostate
cancer usually grows very slowly, and finding and treating it before
symptoms occur may not improve men's health or help them live longer.
Prostate screening tests might include: Digital rectal exam (DRE) and
Prostate-specific antigen (PSA) test. Factors that may increase your risk
of prostate cancer include: Family history and Obesity.
THANK YOU