Reproductive Health Module: Prostate Cancer. Prostate Cancer: Description Cancer of the prostate...
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Transcript of Reproductive Health Module: Prostate Cancer. Prostate Cancer: Description Cancer of the prostate...
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
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