Reproductive Health Module: Prostate Cancer

Prostate Cancer: DescriptionCancer 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: ScreeningRegular 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 causeHormone dependent gland (androgen)Genetic tendencyIncreased incidence with ageHigh fat dietSmokingAny factors reducing immunity

Prostate Cancer: Pathophysiology

Mutation and abnormal cell divisionEnlargement encroaching on the urethra and

bladder neck → obstructionProliferation to surrounding tissues (rectum,

seminal vesicles)Metastastic spread to lymph nodes and bone

(hip, spine)

Prostate Cancer: Clinical ManifestationsSymptoms may not be evident until the

condition is advanced:Frequency, urgency, nocturiaPoor streamDribblingInadequate bladder emptyingHaematuriaWeight loss, malaise, anaemiaRectal/ perineal discomfortBack/ hip pain

Prostate Cancer: DiagnosisRectal 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: StagingGleason 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 tumourLower scores indicate well-differentiated, less

aggressiveHigher scores indicate undifferentiated, aggressiveCombined score of 8 – 10 shows high-grade cancer

Prostate Cancer: Management

SurgeryRadiation therapyHormonal therapyChemotherapy

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 impotenceIf surgery not tolerated cryotherapy may be

used to freezeOrchidectomy 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 urineTemporary side-effects of radiotherapy:

proctitis, enteritis, cystitis

Prostate Cancer: Hormonal TherapyThe prostate is androgen dependent therefore

androgen withdrawal → atrophy of prostatic epithelium:

Reduces size of tumourReduces pain from metastases/ promotes well-

beingOestrogens inhibit gonadotrophin therefore

reduce androgen productionAnti-androgen drug: EulexinOrchidectomy: 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/ chemotherapyThe effects of hormonal therapyNursing 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

ICUIVI and blood transfusion as requiredA 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)

PhysioAnti-embolism stockings

Prostatectomy: Nursing ConsiderationsICU; IVI and blood transfusion as requiredCareful monitoring of vital signs Accurate intake/ output including irrigationMonitor 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-upRegular follow-up:

Rectal examination PSABone scansPhysical examination for lymph gland involvementCBC: monitor cell count (risk of bone marrow

suppression (anaemia/ thrombocytopaenia/ leukopenia) following radiotherapy or chemotherapy)