What is Prostate Cancer
- Is the second leading cause of carcinoma in men older than age 65.
- The cause of the prostate cancer is unknown; there is an increased risk for people with a family history of the disease, and the influence of dietary fat, serum testosterone, vasectomy, and industrial toxins is under investigation.
- Most prostate cancers are adenocarcinoma and are palpable on rectal examination because they are arise form the posterior portion of the gland.
- Prostate cancer usually multifocal, slow growing, and can spread by local extension, by lymphatics or through the bloodstream.
- Complications include bone metastasis leading to vertebral collapse, spinal cord compression, and pathologic fractures, or spread to urinary tract to pelvic lymph nodes.
- First symptoms are caused by obstructed urinary flow, including hesitancy and straining on voiding, frequency, nocturia, reduced size and force of urinary stream.
- A firm to hard nodule may be felt on rectal examination of the prostate.
- Pain in lumbosacral area radiating to hips and down leg (from bone metastases).
- Perineal and rectal discomforts.
- Anemia, weight loss, weakness, nausea, oliguria (from uremia).
- Low extremity edema – occurs when pelvic node metastases compromise when venous return.
- Needle biopsy (through anterior rectal wall or through perineum) for histologic study of biopsy tissue or aspiration for cytologic study.
- Transrectal ultrasonography delineates tumor.
- Prostate-specific antigen (PSA)
- Metastatic workup may include skeletal x-ray, bone scan, and CT or MRI to detect local extension, bone, and lymph node involvement.
- In many patients older than age 70, no treatment may be indicated because the cancer may be slow growing and will not be the cause of death. Instead, the patients should be followed closely with periodic serum PSA testing and examined for evidence of metastasis.
- In advanced prostatic cancer not responsive to treatment, palliative measures include analgesics and opioids to relieve pain, short course of radiation therapy and transurethral resection of the prostate.
- Extreme beam radiation using linear accelerator focused on the prostate.
- Interstitial radiation (brachytherapy).
- Hormone manipulation deprives tumor cells of androgens or their by products and thereby alleviates symptoms and retards progress of disease.
- Analogs of luteinizing hormone-releasing hormone (LNRH), such as leuprolide, reduce testosterone levels.
- Antiandrogen drugs that blocks androgen action directly at the target tissues and block androgen synthesis within the prostate gland.
- Combination therapy with LHRH analogs and flutamide blocks the action of all circulating androgen.
- Complications of hormonal manipulation include hot flashes, nausea, and vomiting, gynecomastia, and sexual dysfunction.
- Radical prostatectomy – removal of entire prostate gland, prostatic capsule, and seminal vesicles, may include pelvic lymphadenectomy.
- Cryosurgery freezes prostate tissue, killing tumor cells without prostatectomy.
- Bilateral orchiectomy (removal of testes) result in reduction of the major circulating androgen, testosterone, as a palliative measure to reduce symptoms and progression.
- Assess pain control. Make sure that the patient is not undermedicated.
- Teach relaxation techniques such as imagery, music therapy, and progressive muscle relaxation as adjunct to pain control.
- Employ safety measures to prevent pathologic fractures, such as prevention of falls if bone metastasis is present.
- To reduce anxiety, give repeated explanations of diagnostic tests and treatment options, and help the patient gain some feeling of control over disease and decisions.
- To help achieve optimal sexual function, give the patient the opportunity to communicate his concerns and sexual needs.
- Inform the patient that decreased libido expected after hormonal manipulation therapy, and that impotence may result from some surgical procedures and radiation.
- Suggest options such as sexual counseling, learning other options of sexual expression, and consideration of penile implant.
- Emphasize the importance of follow-up for check of PSA levels and evaluation for disease progression.
- Teach the patient to administer hormonal agents intramuscularly or subcutaneously as indicated.
- If bone metastasis has occurred, encourage safely measures around the home to prevent pathologic fractures, such as removal of throw rugs, using handrail on stairs, and using nightlights.
- Advise the patient to report symptoms of worsening urethral obstruction, such as increased frequency, urgency, hesitancy, and urinary retention.
- Encourage all men to seek medical screening for prostate cancer.