Adult Medical - Surgical Nursing Reproductive Health Module: Prostate Cancer

Prostate Cancer: Description Cancer of the prostate gland is the most common cancer in men Early detection (screening) is simple and potentially life-saving All men > 50 years are advised to be screened annually

Prostate Cancer: Screening Regular digital rectal examination: The prostate gland is felt as hard, stony, fixed, nodular (benign hypertrophy is soft, rubbery) ↑ Prostate Specific Antigen (PSA): (Also elevated with benign prostatic hypertrophy therefore does not definitively diagnose malignancy)

Prostate Cancer: Aetiology Unknown cause Hormone dependent gland (androgen) Genetic tendency Increased incidence with age High fat diet Smoking Any factors reducing immunity

Prostate Cancer: Pathophysiology Mutation and abnormal cell division Enlargement encroaching on the urethra and bladder neck → obstruction Proliferation to surrounding tissues (rectum, seminal vesicles) Metastastic spread to lymph nodes and bone (hip, spine)

Prostate Cancer: Clinical Manifestations Symptoms may not be evident until the condition is advanced: Frequency, urgency, nocturia Poor stream Dribbling Inadequate bladder emptying Haematuria Weight loss, malaise, anaemia Rectal/ perineal discomfort Back/ hip pain

Prostate Cancer: Diagnosis Rectal examination (hard stony fixed nodular prostate gland) ↑ PSA (proportional to prostatic mass: also monitors effectiveness of treatment) Needle biopsy (transperineal/ ultrasound control): histology of prostate tissue (staging) Prostatic fluid sample (histology/ culture) Trans-rectal ultrasound KFT, urography, Bone scan/ Xray

Prostate Cancer: Staging Gleason Score: A score (1-5) is assigned to the most predominant architectural pattern of the gland and (1-5) for the second most predominant. Reported as: 2 + 4 (example). Combined value up to 10 The higher the value, the more aggressive the tumour Lower scores indicate well-differentiated, less aggressive Higher scores indicate undifferentiated, aggressive Combined score of 8 – 10 shows high-grade cancer

Prostate Cancer: Management Surgery Radiation therapy Hormonal therapy Chemotherapy A combination of therapies

Prostate Cancer: Surgery Radical Prostatectomy: removal of the prostate and seminal vesicles May be performed in early stage (10 year or more life-expectancy) Results in impotence If surgery not tolerated cryotherapy may be used to freeze Orchidectomy may be also performed: (↓ androgen)

Prostate Cancer: Radiation Therapy If detected early: Linear Accelerator (6-7 week therapy) or Implantation of radioactive iodine or palladium seeds: Requires minimal exposure to others: Use of condom/ strain urine Temporary side-effects of radiotherapy: proctitis, enteritis, cystitis

Prostate Cancer: Hormonal Therapy The prostate is androgen dependent therefore androgen withdrawal → atrophy of prostatic epithelium: Reduces size of tumour Reduces pain from metastases/ promotes well-being Oestrogens inhibit gonadotrophin therefore reduce androgen production Anti-androgen drug: Eulexin Orchidectomy: promotes androgen withdrawal since 93% of testosterone (androgen) is produced by the testes

Prostate Cancer: Psychological Impact There is a severe emotional self-image impact from: Surgery (prostatectomy) inducing impotence Hormone changes Orchidectomy Fear and apprehension related to the diagnosis

Prostate Cancer: Nursing Considerations Public health awareness of the importance of regular screening for early detection Emotional and psychological support to patient and family: specialist counselling Patient awareness/ precautions related to: Radiotherapy/ chemotherapy The effects of hormonal therapy Nursing care surrounding surgery

Surgery: Radical Prostatectomy

Prostatectomy: Potential Complications Haemorrhage (radical surgery; the prostatic tumour is very vascular) Clot retention: risk of obstruction of urine flow by clots forming in the catheter lumen Deep venous thrombosis/ pulmonary embolism

Prostatectomy: Management ICU IVI and blood transfusion as required A 3-way Foley catheter is used for continuous irrigation of the bladder with saline to flush away clots IV antibiotics (including Gentamycin to prevent gram negative shock) (also given when catheter removed) Physio Anti-embolism stockings

Prostatectomy: Nursing Considerations ICU; IVI and blood transfusion as required Careful monitoring of vital signs Accurate intake/ output including irrigation Monitor urine colour (for ↑ haemorrhage) Monitor drainage: “milk” clots to encourage urine flow (note supra-pubic distension, pain, restlessness) Bladder washout if required (analgesia important) Encourage oral fluids. Physio. Antibiotics

Prostate Cancer: Follow-up Regular follow-up: Rectal examination PSA Bone scans Physical examination for lymph gland involvement CBC: monitor cell count (risk of bone marrow suppression (anaemia/ thrombocytopaenia/ leukopenia) following radiotherapy or chemotherapy)