1. Adult Medical - Surgical Nursing
Reproductive Health Module:
Prostate Cancer

2. 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

3. 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)

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

5. 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)

6. 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

7. 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

8. 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: (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

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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. Surgery: Radical Prostatectomy

16. 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

17. 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

18. 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

19. 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)