CANCER OF THE PROSTATE • nausea
• oliguria (decreased urine output).
Prostate cancer is the most common cancer in
men other than nonmelanoma skin cancer and
the second most common cause of cancer deaths
in American men older than 55 years of age
(Greenlee et al., 2001).
Risk factors for prostate cancer include:
• increasing age: The peak incidence of
prostate cancer is in men between the
ages of 60 and 70; 85% of the cases are
diagnosed in men over the age of 65.
• Race: African American men have the
highest incidence of prostate cancer in the
world.
• Genetics: Having a father or brother with
prostate cancer doubles the risk; the risk
increases further if several relatives have
had prostate cancer and if the relatives
were young at diagnosis.
• Diet: A diet high in red meat and fat
increases the risk for prostate cancer
(American Cancer Society, 2002).
• Environment: Environmental exposure to
cadmium (an element found in cigarettes
and alkaline batteries) is also considered a
risk factor.
Clinical Manifestations
Cancer of the prostate in its early stages rarely
produces symptoms.
The symptoms that develop from urinary
obstruction occur late in the disease. This cancer
tends to vary in its course.
If the neoplasm is large enough to encroach on
the bladder neck, signs and symptoms of urinary
obstruction occur:
• difficulty and frequency of urination
• urinary retention
• decreased size and force of the urinary
stream
• blood in the urine or semen
• painful ejaculation.
Prostate cancer can metastasize to bone and
lymph nodes. Symptoms related to metastases
include:
• backache
• hip pain
• perineal and rectal discomfort
• anemia
• weight loss
• weakness
Unfortunately, these symptoms may be the first
indications of prostate cancer.
Assessment and Diagnostic Findings
When prostate cancer is detected early, the
likelihood of cure is high.
Digital Rectal Examination
• Every man older than 40 years of age
should have a DRE as part of his regular
health check-up.
• early cancer may be detected as a nodule
within the substance of the gland or as an
extensive hardening in the posterior lobe.
• The more advanced lesion is “stony hard”
and fixed.
• DRE also provides useful clinical
information about the rectum, anal
sphincter, and quality of stool.
Histology
• The diagnosis of prostate cancer is
confirmed by a histologic examination of
tissue removed surgically by transurethral
resection, open prostatectomy, or
transrectal needle biopsy.
• Fine needle aspiration is a quick, painless
method of obtaining prostate cells for
cytologic examination.
Serum Prostate Specific Antigen
• PSA, a neutral serine protease, is
produced by the normal and ductal
epithelium of the prostate and secreted
into the glandular lumen (Brawer, Cheli,
Neaman et al., 2000; Kalish & McKinlay,
1999).
• The concentration of PSA in the blood is
proportional to the total prostatic mass.
• Although the PSA level indicates the
presence of prostate tissue, it does not
necessarily indicate malignancy.
• PSA testing is routinely used to monitor
the patient’s response to cancer therapy
and to detect local progression and early
recurrence of prostate cancer.
Transrectal Ultrasound Studies
• are indicated for men who have elevated
PSA levels and abnormal DRE findings.
• TRUS studies help in detecting
nonpalpable prostate cancers and assist
with staging localized prostate cancer.
• Needle biopsies of the prostate are
commonly guided by TRUS.
Other tests include:
• bone scans to detect metastatic bone
disease
• skeletal x-rays to identify bone
metastases
• excretory urography to detect changes
caused by ureteral obstruction
• renal function tests
• computed tomography (CT) scans or
lymphangiography to identify metastases
in the pelvic lymph nodes.

MEDICAL MANAGEMENT
Treatment is based on the stage of the disease
and the patient’s age and symptoms.
RADIATION THERAPY
Teletherapy involves about 6 to 7 weeks of daily
(5 days/week) radiation treatments. Interstitial
seed implantation is performed under anesthesia.
About 80 to 100 seeds are placed with ultrasound
guidance and the patient returns home after the
procedure. Exposure of others to radiation is
minimal, but close contact with pregnant women
and infants should be avoided for up to 2
months.
Side effects:
• Inflammation of the rectum, bowel,
and bladder (proctitis, enteritis, and
cystitis)
• pain with urination and during
ejaculation
HORMONAL THERAPY
Hormonal therapy for advanced prostate
cancer suppresses androgenic stimuli to the
prostate. As a result, the prostatic epithelium
atrophies (decreases). This effect is
accomplished either by orchiectomy (removal
of the testes) or by the administration of
medications.
Orchiectomy lowers plasma testosterone levels
because about 93% of circulating testosterone is
of testicular origin. As a result, the testicular
stimulus required for continued prostatic growth
is removed, resulting in prostatic atrophy.
Estrogen therapy, usually in the form of
diethylstilbestrol (DES), has long been used to
inhibit the gonadotropins responsible for
testicular androgenic activity.DES relieves
symptoms of advanced prostate cancer, reduces
tumor size, decreases pain from metastatic
nodules, and promotes well-being. However, DES
significantly increases the risk for
thromboembolism, pulmonary embolism,
myocardial infarction, and stroke. Other side
effects of estrogen therapy include impotence,
decreased libido, difficulty in achieving orgasm,
decreased sperm production, and gynecomastia
(enlargement of breasts in men).
Newer hormonal therapies include: the
• luteinizing hormone– releasing hormone
(LH-RH) agonists (leuprolide [Lupron] and
• goserelin [Zoladex]) and
• antiandrogen agents, such as flutamide
(Eulexin).
In contrast to estrogen, the newer hormonal
agents are associated with a lower incidence of
cardiovascular side effects, gynecomastia, and
decreased sexual function.
OTHER THERAPIES
Cryosurgery of the prostate is used to ablate
prostate cancer in patients who could not
physically tolerate surgery or in those with
recurrent prostate cancer. Transperineal probes
are inserted into the prostate under ultrasound
guidance to freeze the tissue directly.
Chemotherapy, such as doxorubicin, cisplatin,
and cyclophosphamide, may also be used.
Opioid and nonopioid medications are used to
control the pain.
Antiandrogen therapies are used in an effort to
reduce the circulating androgens.
SURGICAL MANAGEMENT
Transurethral Resection of the Prostate
Suprapubic Prostatectomy
Perineal Prostatectomy
Retropubic Prostatectomy
Laparoscopic Radical Prostatectomy
NURSING MANAGEMENT
Dispel misconceptions and explain all diagnostic
procedures.
Encourage the patient and his partner to
verbalize their feelings and fears.
Be alert for behavior indicating denial, grief,
hostility, or depression.
Be sensitive to the patient’s fear of his loss of
masculinity. Reinforce that having the testes
removed in adulthood does not affect the ability
to have an erection and orgasm.
Ask about pain regularly, and assess pain
systematically.
Implement postoperative strategies to decrease
complications.
Patients are usually able to ambulate on the first
day after surgery. Help the patient to get out of
bed and walk in the halls to his tolerance level,
usually three or four times a day.
Instruct patient not to perform Valsalva
maneuver for 6 – 8 weeks because it increases
venous pressure and may produce hematuria.
Encourage fluids to avoid dehydration and clot
formation.
References:
Smeltzer, S.C., et al (2006). Brunner and
Suddarth’s Textbook of Medical – Surgical
Nursing, 11th Ed. Philadelphia: Lippincott
Williams and Wilkins.
Sommers, M.S. et al (2007). Diseases and
Disorders: A Nursing Therapeutics Manual,
3rd Ed. Philadelphia: F.A. Davis Company