Professional Documents
Culture Documents
Cancer
What is a Prostate?
The Prostate is a large gland of 30-50 smaller
glands and bundles of smooth muscle
It produces a fluid called semen that contains
sperm
It is located just beneath the urinary bladder and
is about the size of a walnut
Prostate Cancer
A disease in which the cells of the prostate become abnormal and
start to grow uncontrollably, forming tumors (Fallon, pg 2774-2779).
Mortality from Prostate cancer is the second most common cause of
cancer death in men (Jones, 2013).
Prostate cancer is usually multifocal and slow growing
Most prostate cancers are adenocarcinomas
PSA (Prostate Specific Antigen) is used to monitor the progression of
the disease, a score <4.0 ng/mL is considered to be normal
According to the National Cancer Institute, Prostate Cancer can be
grouped into 3 different stages.
1. Local: no sign that the cancer has spread outside of the prostate
2. Regional: those that have spread to nearby areas including
the lymph nodes
3. Distant: those that spread to distant lymph nodes,
bones, or other organs
Prostate Cancer
Symptoms/
Assessment
Assessment
Diagnosis
DRE (Digital Rectal Exam): lubricated gloved finger into the rectum to
palpate prostate for lumps
*If any abnormalities are noted, additional tests
are completed
CBC (Complete Blood Count): protein markers such
as PSA (prostate-specific antigen)
Transrectal Ultrasound: a small transducer is placed in the rectum
and releases sound waves that bounce off the prostate tissue to
create an image using reflected sound waves
Prostate Biopsy: physician will use a hollow needle to remove a small
piece
of prostate tissue.
Gleason System: after biopsy is taken, a pathologist will grade the
tissue
on a scale of 2-10. 2 being the least aggressive, and 10 being the
most.
Diagnostic Studies
Diagnostic studies are done to determine
if cancer has spread to other parts of the
body
MRI
CT
X-RAY
Bone Scan
ProstaScint (used to check for prostate
cancer cells in the lymph nodes or other
soft tissues)
Diagnostic Studies
Treatment
Treatment depends on Age, stage of tumor,
general health, comorbidities, personal
preference, and risks
Surgery
Cryosurgical ablation
Radiation therapy
Hormone therapy
Brachytherapy
Chemotherapy
Watchful waiting
Surgery
Radical prostatectomy (removes entire
prostate, only in men in good health and no
comorbidities)
Suprapubic prostatectomy
Retropubic prostatectomy
Perineal prostatectomy
TURP (Transurethral resection of the prostate)
Only cancerous portion is removed, not
recommended unless your age or illness
prevents a radical prostatectomy
Nerve sparing prostatectomy (limits risks)
Radiation Therapy
Involves high energy x-rays to shrink
or kill cancer cells
External Beam radiation
Brachytherapy involves placing
radioactive seeds Inside the prostate
gland.
(Can only be used if you have a low
Gleason
score and low PSA level).
Hormone Therapy
Used when cancer is advanced and has
spread to other parts of the body
Decreasing testosterone will inhibit or
shrink the cancer
Orchiectomy: surgical removal of the
testicles to decrease testosterone
LHRH (Luteinizing hormone releasing
hormone): stimulates release of LH
hormone from pituitary to decrease
testosterone
Estrogen: signals the body to stop making
Chemotherapy
Docetaxal (Taxotere): A plant alkaloid that
is given through IV
Depending on stage of cancer, can be
given in pill form or systemically injected
Watchful Waiting
People who are diagnosed with a
non-aggressive form of prostate
cancer may be under careful
observation with no immediate
treatment
Nursing Diagnosis
Nursing
Interventions/Teaching
Prevention
According to the American Cancer Society, early detection
and better screening methods has increased the survival
rate for all stages of prostate cancer over the last 30 years
Screening begins at age 40
Annual digital rectal exams
Questions
1.Thenurseisteachingagroupofmenaboutprostatecancer.Whichofthe
followingpointsshouldbeincludedintheinstruction?Selectallthatapply.
1.Prostatecancerisusuallymultifocalandslowgrowing.
2.Mostprostatecancersareadenocarcinoma.
3.TheincidenceofprostatecancerishigherinmenofAfricandescent,
andtheonsetisearlier.
4.Aprostatespecificantigen(PSA)labtestgreaterthan4ng/mgwillneed
tobemonitored.
5.Cancercellsaredetectableintheurine.
Questions
1,2,3,4Canceroftheprostateglandisthesecondleadingcauseofcancer
deathamongAmericanandCanadianmenandisthemostcommon
carcinomainmenolderthanage65.Incidenceofprostatecancerishigher
inmenofAfricandescent,andonsetisearlier.Mostprostatecancersare
adenocarcinoma.Prostatecancerisusuallymultifocal,slowgrowing,and
canspreadbylocalextension,bylymphatics,orthroughthebloodstream.
Prostatespecificantigen(PSA)greaterthan4ng/mgisdiagnostic;afree
PSAlevelcanhelpstratifytheriskofelevatedPSAlevels.Metastatic
workupmayincludeskeletalxray,bonescan,andcomputedtomography
ormagneticresonanceimagingtodetectlocalextension,bone,andlymph
nodeinvolvement.Theurinedoesnothaveprostatecancercells.
Questions
2.Whenaclientisreceivinghormonereplacementforprostatecancer,the
nurseshoulddowhichofthefollowing?Selectallthatapply.
1.Informtheclientthatincreasedlibidoisexpectedwithhormonetherapy.
2.Reassuretheclientthaterectiledysfunctionwillnotoccurasa
consequenceofhormonetherapy.
3.Providetheclienttheopportunitytocommunicateconcernsandneeds.
4.Utilizecommunicationstrategiesthatenabletheclienttogainsome
feelingofcontrol.
5.Suggestthatanappointmentbemadetoseeapsychiatrist.
Questions
3,4.Hormonemanipulationdeprivestumorcellsofandrogensortheir
byproductsand,thereby,alleviatessymptomsandretardsdisease
progression.Complicationsofhormonalmanipulationincludehotflashes,
nauseaandvomiting,gynecomastia,andsexualdysfunction.Aspartof
supportivecare,provideexplanationsofdiagnostictestsandtreatment
optionsandhelptheclientgainsomefeelingofcontroloverhisdisease
anddecisionsrelatedtoit.Tohelpachieveoptimalsexualfunction,give
theclienttheopportunitytocommunicatehisconcernsandsexualneeds.
Informtheclientthatdecreasedlibidoisexpectedafterhormonal
manipulationtherapy,andthatimpotencemayresultfromsomesurgical
proceduresandradiation.Apsychiatristisnotneeded.
Questions
3.Aclientwithprostatecanceristreatedwithaluteinizinghormonereleasing
hormoneagonist.Thenurseshouldinstructtheclienttoexpecttohave:
1.Tendernessofthescrotum.
2.Flushing.
3.Lossofpubichair.
4.Decreasedbloodpressure.
Questions
2.Acommonsideeffectisflushingorhotflashes.Changesinblood
pressure,tendernessofthescrotum,anddramaticchangesinsecondary
sexualcharacteristicsshouldnotoccur.
Questions
4.Thenurseiscaringoraclientwhowillhaveabilateralorchiectomy.The
clientaskswhatisinvolvedwiththisprocedure.Thenursesmostappropriate
responsewouldbe?Thesurgery:
1.Removestheentireprostategland,prostaticcapsule,andseminal
vesicles.
2.Tendstocauseurinaryincontinenceandimpotence.
3.Freezesprostatetissue,killingcells.
4.Resultsinreductionofthemajorcirculatingandrogen,testosterone.
Questions
4.Bilateralorchiectomy(removaloftestes)resultsinreductionofthe
majorcirculatingandrogen,testosterone,asapalliativemeasuretoreduce
symptomsandprogressionofprostatecancer.Aradicalprostatectomy
(removalofentireprostategland,prostaticcapsule,andseminalvesicles)
mayincludepelviclymphadenectomy.Complicationsincludeurinary
incontinence,impotence,andrectalinjurywiththeradicalprostatectomy.
Cryosurgeryfreezesprostatetissue,killingtumorcellswithout
prostatectomy.androgen,testosterone.
Questions
5.Thenurseisperformingadigitalrectalexamination.Whichofthe
followingfindingsisakeysignorprostatecancer?
1.Ahardprostate,localizedordiffuse.
2.Abdominalpain.
3.Aboggy,tenderprostate.
4.Anoninduratedprostate.
Questions
1.Ondigitalrectalexamination,keysignsofprostatecancerareahard
prostate,indurationoftheprostate,andanirregular,hardnodule.
Accompanyingsymptomsofprostatecancercanincludeconstipation,
weightloss,andlymphadenopathy.Abdominalpainusuallydoesnot
accompanyprostatecancer.Aboggy,tenderprostateisfoundwith
infection(eg,acuteorchronicprostatitis).
Questions
6.Aclientisundergoingatotalprostatectomyorprostatecancer.Theclient
asksquestionsabouthissexualfunction.Thebestresponsebythenurseis
whichofthefollowing?Lossoftheprostateglandmeansthat:
1.Youwillbeimpotent.
2.Youwillbeinfertileandtherewillbenoejaculation.Youcanstill
experiencethesensationsoforgasm.
3.Youwillhavenolossofsexualfunctionanddrive.
4.Yourerectilecapabilitywillreturnimmediatelyaftersurgery.
Questions
2.Lossoftheprostateglandinterruptstheflowofsemen,sotherewillbe
noejaculationfluid.Thesensationsoforgasmremainintact.Theclient
needstobeadvisedthatreturnoferectilecapabilityisoftendisruptedafter
surgery,butwithin1year95%ofmenhavereturnedtonormalerectile
functionwithsexualintercourse.
Questions
7.WhichistheAmericanCancerSociety'srecommendationforearly
detectionofprostatecancer?
1.YearlyPSAandDREbeginningatage40.
2.Biannualrectalexambeginningatage50.
3.Semiannualalkalinephosphataselevelbeginningatage45.
4.Yearlyurinalysistodeterminepresenceofprostaticfluid.
Questions
1.YearlyPSAandDREbeginningatage40.Screeningscanhelpfind
cancersatanearlierstagewhentreatmentismoresuccessful.
Questions
8.Thenurseiscaringforaclientwithcanceroftheprostatefollowinga
prostatectomy.Thenurseprovidesdischargeinstructionstotheclientandtells
theclientto:
1.avoiddrivingthecarfor1week
2.restrictfluidintaketopreventincontinence
3.avoidliftingobjectsheavierthan20lbforatleast6weeks
4.notifythephysicianifsmallbloodclotsarenoticedduringurination
Questions
3.avoidliftingobjectsheavierthan20lbforatleast6weeks.Theclient
whohasundergoneaprostatectomyshouldavoidliftingobjectsheavier
than20lbforatleast6weeks.Drivingacarandsittingforlongperiods
arerestrictedforatleast3weeks.Ahighdailyfluidintakeshouldbe
maintainedtolimitclotformationandpreventinfection.Smallpiecesof
tissueorbloodclotsmaybepassedduringurinationforupto2weeksafter
surgery;thisisanexpectedoccurrence.
Questions
9.The80y.o.maleclientisdiagnosedwithprostatecancer.Whichtreatment
wouldthenursediscusswithhim?
1.Radiationtherapyeverydayfor4weeks.
2.Radicalprostatectomywithlymphnodedissection.
3.Diethylstilbestrol(DES),anestrogen,daily.
4.Penileimplantstomaintainsexualfunctioning.
Questions
3.Diethylstilbestrol(DES),anestrogen,daily.Estrogentakendailycan
lowertestosterone.Testosteronecontributestoprostateglandgrowth
whichmakesthecancergrow.
Questions
10.Aclientisdiagnosedwithprostatecancer.Whichtestisusedto
monitorprogressionofthisdisease?
1.Serumcreatinine
2.Completebloodcellcount(CBC)
3.Prostatespecificantigen(PSA)
4.Serumpotassium
Questions
3.Prostatespecificantigen(PSA).PSAhastobemonitoredcloselywhen
patientshaveprostatecancer,anyelevationwouldindicatemetastasizeof
thecancer
Citation
Billings,D.M.,&Hensel,D.(2015).Lippincott'sQ&AreviewforNCLEXRN.
Philadelphia:WoltersKluwer/LippincottWilliams&WilkinsHealth.
Fallon,L.F.,&Oberleitner,M.(2013).ProstateCancer.InB.Narins(Ed.),The
GaleEncyclopediaofNursingandAlliedHealth(3rded.,Vol.5,pp.27742779).
Detroit:Gale.Retrievedfromhttp://go.galegroup.com/ps/i.do?
p=GVRL&sw=w&u=cuny_statenisle&v=2.1&it=r&id=GALE
%7CCX2760400890&sid=exlibris&asid=8bd5ef445914d90564a4dbf823f2129f
Jones,J.(2013).ProstatecancerdiagnosisPSA,biopsyandbeyond(Current
clinicalurology).NewYork:HumanaPress.
Silvestri,LindaAnne.SaundersComprehensiveReviewfortheNCLEXRN
Examination.N.p.:n.p.,n.d.Print.