Prostate Cancer
April Love R. Oja, RN, MAN
Prostate Cancer
● Prostate cancer is the most common cancer in men other
than nonmelanoma skin cancer. It is the second most
common cause of cancer death in American men, exceeded
only by lung cancer, and is responsible for 10% of cancer-
related deaths in men. Among men diagnosed with prostate
cancer, 98% survive at least 5 years, 84% survive at least 10
years, and 56% survive 15 years (ACS, 2015).
● Prostate cancer is the fourth leading cancer site for Filipino
males with about eight new cases every day. One out of 100
males would have died from this disease before age 75.
Prostate cancer occurs mainly in older men. About 6 cases in
10 are diagnosed in men aged 65 or older, and it is rare
before age 40.
Risk Factors
Race: African- Familial
Age
American men Predisposition
diet containing
Genetic Mutations-
excessive amounts
BCRA2 mutations/ S-
of red meat or dairy
transferase (GSTPI)
products that are
gene.
high in fat
Clinical Manifestations
Early stages Signs of urinary Blood in the urine Sexual Symptoms of
metastases
rarely produces obstruction: or semen and dysfunction backache, hip pain,
symptoms difficulty and painful perineal and rectal
frequency of ejaculation discomfort, anemia,
urination, urinary weight loss,
retention, and weakness, nausea,
oliguria (decreased
decreased size urine output),and
and force of the spontaneous
urinary stream. pathologic fractures
Diagnostic Findings
Digital Rectal Exam-
• early cancer may be detected
as a nodule within the gland or
as an extensive hardening in
the posterior lobe
Prostate Specifc Antigen
(PSA)-
• shows an elevated level
Diagnostic Findings
Histologic examination
• tissue done via TURP, open
prostatectomy or ultrasound
–guided transrectal needle
biopsy
Diagnostic Findings
Transrectal
Ultrasound
(TRUS)-
• helps detect
nonpalpable
prostate cancers
and assists with
staging of
localized prostate
cancer
Medical Management
Nonsurgical watchful waiting
• involves actively monitoring the course of disease and intervening only if the cancer
progresses or if symptoms warrant other intervention. It is an option for patients with life
expectancy of less than 5 years and low-risk cancers.
• Advantages
• absence of side effects of more aggressive treatment
• improved quality of life, avoidance of unnecessary treatment
• decreased initial costs
• Disadvantages
• missed chance at cure
• risk of metastasis
• subsequent need for more aggressive treatment
• anxiety about living with untreated cancer
• need for frequent monitoring
Surgical Management
Radical
Prostatectomy
• -removal of the entire
prostate gland, seminal
vesicles, and part of
the bladder neck
Surgical Managament
Radical Prostatectomy
• Retropubic Prostatectomy
• Performed because it allows
adequate control of bleeding,
visualization of the prostate bed
and bladder neck, and access to
pelvic lymph nodes
• Perineal Prostatectomy
• Is often preferred for older men or
thise who are poor surgical risks.
This approach requires less time
and involves less bleeding
Surgical Management
Laparoscopic radical
prostatectomy
• is an MIS for cure ofpatients
who have a PSA less than 10
ng/mL and who have had no
previous hormone therapy or
abdominal surgeries.
• Laparoscopic surgery differs
from traditional open surgery by
making five small incisions as
opposed to one large one to
perform the surgery.
Radical prostatectomy Post –Op
Contraptions
Large indwelling catheter with 20-ml or 30-ml balloon in the
bladder via the urethra
Adverse Outcomes
ED and urinary ncontinence
Sexual function after surgery tends to return gradually over
atleast 24 months or more
Phosphodiesterase type 5 (PDE5) inhibitor – may help
improve sexual function
Problems with urinary control
May occur during the first few months after the surgery
Advise: Kegel exercises
Medical Management
Radiation Therapy
External beam radiation therapy (EBRT)
comes from a sourceoutside the body.
Patients are usually treated 5 days each
week for 6 to 9 weeks
• Complications of EBRT may include:
• ED
• Acute radiation cystitis
• Radiation proctitis
Medical Management
Internal radiation
therapy (brachytherapy)
• can be delivered by
implanting low-dose
radiation seeds directly into
and around the prostate
gland.
Medical Management
Hormone therapy :
Bilateral orchiectomy (surgery)
• To remove the testosterone
influence
Luteinizing hormone-releasing
hormone (LH-RH) agonists or
antiandrogens (drugs) can be given.
• Side effects of hormone therapy
may include:
• Hot flashes
• Gynecomastia (breast
development)
Medical Management
Chemotherapy
• Systemic cytotoxic chemotherapy is an option
for patients whose cancer has spread and for
whom other therapies have not worked.
• Commonly used agents for prostate cancer
include docetaxel (Taxotere), cisplatin (Platinol),
and etoposide (VP-16, VePesid).
Nursing Management
Provide preoperative care
Relieve Discomfort Provide Education Prepare the patient
• Bed rest and analgesics • Teach patient about the • Antiembolic stockings (if
• Insertion of Indweeling probable location of the patient will be placed in a
Catheter surgical incision, the use lithotomy position)
Reduce anxiety of an indwelling urinary • Enema
catheter, placement of
drains, and the possibility
of temporary ED.
Nursing Management
Post-operative Care
Monitor for Potential
Complication
Relieve Pain • Hemorrhage
• Infection
• Venous Thromboembolism
Nursing Management
Ambulatory Care
Teach catheter care if Watch out for signs of If urinary incontinence is
patient is discharged with infection a problem
an indwelling catheter • Baldder spasms • Kegel Exercises
• Keep collecting bag lower than • Fever
bladder at all times • hematuria
• Keep catheter securely
anchored to the inner thigh or
the abdomen
Nursing Management
Palliative and End-of Life Care
Common Problems: Pain Management’
• Fatigue • Opioid and nonopoiod analgesics
• Bladder outlet obstructions • Relaxation, breathing exercises
• Ureteral obstructions
• Severe bone pain / fractures
• Spinal cord compression
• Leg edema
Thank you
