Prepared by; Castillo, Reymar John Escultero, Jennyfer Haresco, Ricca Joy Mapa, Lawrence Steve BSN 4 - B

It helps control urination by pressing directly against the part of the urethra that it surrounds. The main function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar.

Prostate cancer is the second leading cause of deaths from cancer among U.S. men. While the causes of prostate cancer are still unknown, some risk factors for the disease, such as advancing age and a family history have been identified. Prostate cancer is often initially suspected because of an abnormal PSA blood test or a hard nodule (lump) felt on the prostate gland during a routine digital (done with a finger) rectal examination. If one of the screening tests is abnormal, the diagnosis of prostate cancer should be suspected and a biopsy of the prostate gland is usually done.

The diagnosis of prostate cancer is made when cancerous prostatic cells are identified in the biopsy tissue under a microscope. In some men, prostate cancer is life threatening, while in many others, it can exist for many years without causing health problems. The choice of treatment for prostate cancer depends on the size, aggressiveness, and extent or spread of the tumor, as well as on the age, general health, and preference of the patient. The many options for treating prostate cancer include surgery, radiation therapy, hormonal treatment, cryotherapy, chemotherapy, combinations of some of these treatments, and watchful waiting/active surveillance.

Prostate cancer is a form of cancer that develops in the prostate. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers

Increasing age, >50 Men, (more commonly affects black men than white) Family history (first-degree relative - father or brother) Obesity elevated blood levels of testosterone consume large amounts of fats and dairy products -particularly from red meat and other sources of animal fat High alcohol, low folic intake Surgery - vasectomy

need to urinate often, especially at night intense need to urinate (urgency) difficulty in starting or stopping the urine flow inability to urinate weak, decreased or interrupted urine stream a sense of incompletely emptying the bladder burning or pain during urination blood in the urine or semen painful ejaculation

Digital rectal exam (DRE)

A digital rectal exam is done for men as part of a complete physical examination to check the prostate gland. This is also done to check for growths in/or enlargement of the prostate gland in men. A tumor in the prostate can often be felt as a hard lump.

Prostate-specific antigen (PSA) test

A prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen in the blood. Normal value: 4.0 ng/mL
May be performed in patients with abnormalities in DRE and in those with elevated PSA levels. May be used in detecting nonpalpable prostate cancers and in staging localized prostate cancers

Transurethral ultrasound

Biopsy confirmatory diagnostic test Imaging techniques

computed tomography (CT) scans magnetic resonance imaging (MRI)

Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. Over time, these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system.

The prostate is a zinc accumulating, citrate producing organ. The protein ZIP1 is responsible for the active transport of zinc into prostate cells. Prostate cancer cells are generally devoid of zinc. This allows prostate cancer cells to save energy not making citrate, and utilize the new abundance of energy to grow and spread. The absence of zinc is thought to occur via a silencing of the gene that produces the transporter protein ZIP1. ZIP1 is now called a tumor suppressor gene product for the gene SLC39A1. Zinc inhibits NF-B pathways, is anti-proliferative, and induces apoptosis in abnormal cells.

The pathologist assigns a grade to the most common tumor pattern, and a second grade to the next most common tumor pattern. The two grades are added together to get a Gleason Score.

Gleason patterns are associated with the following features:

Pattern 1 - The cancerous prostate closely resembles normal prostate tissue. The glands are small, well-formed, and closely packed. Pattern 2 - The tissue still has well-formed glands, but they are larger and have more tissue between them. Pattern 3 - The tissue still has recognizable glands, but the cells are darker. At high magnification, some of these cells have left the glands and are beginning to invade the surrounding tissue. Pattern 4 - The tissue has few recognizable glands. Many cells are invading the surrounding tissue Pattern 5 - The tissue does not have recognizable glands. There are often just sheets of cells throughout the surrounding tissue.

Stage I (or A): The cancer cannot be felt on a digital rectal exam, and there is no evidence that it has spread outside the prostate. These are often found incidentally after surgery for an enlarged prostate.

Stage II (or B): The tumor is larger than a stage I and can be felt on a digital rectal exam. There is no evidence that the cancer has spread outside the prostate. These are usually found on a biopsy when a man has an elevated PSA level.

Stage III (or C): The cancer has invaded other tissues neighboring the prostate. Stage IV (or D): The cancer has spread to lymph nodes or to other organs.

Four types of standard treatment are used:

Watchful waiting
Surgery Radiation therapy Hormone therapy

New types of treatment are being tested in clinical trials.

Cryosurgery

Chemotherapy

Watchful waiting is closely monitoring a patients condition without giving any treatment until symptoms appear or change. This is usually used in older men with other medical problems and earlystage disease.

Transurethral resection of the Prostate

A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra.
Nursing Intervention: After transurethral resection Watch for signs of urethral stricture (dysuria, decreased force and caliber of urine stream, and straining to urinate). Also observe for abdominal distention (a result of urethral stricture or catheter blockage by a blood clot). Irrigate the catheter, as ordered.

Pelvic lymphadenectomy

A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.

Transurethral Incision of the Prostate(TUIP) -is indicated if when prostate gland is small. -another procedure for BHP. - 1 to 2 cuts are made in the prostate to reduce pressure to the urethra and reduce urethral constriction. Nursing Intervention Monitor for hemorrhage

Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles.
Suprapubic Prostatectomy Perineal Prostatectomy Retropubic Prostatectomy

Laparascopic Radical Prostatectomy It is performed through 4-6 small (0.5 in[1cm]) incision in the midabdomen. Nursing Intervention

Monitor for Hemorrhage and shock Monitor for changes in bowel function Observe for symptoms of urethral

stricture(dysuria),straining,weak urinary stream.

Nursing intervention: After prostatectomy Regularly check the dressing, incision, and drainage systems for excessive blood. Also watch for signs of bleeding (pallor, restlessness, decreasing blood pressure, and increasing pulse rate). Be alert for signs of infection (fever, chills, inflamed incisional area). Maintain adequate fluid intake (at least 2,000 ml daily). Give antispasmodics, as ordered, to control postoperative bladder spasms. Also provide analgesics as needed. Because urinary incontinence commonly follows prostatectomy, keep the patients skin clean and dry.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Nursing intervention: After radiation therapy

Watch for the common adverse effects of radiation to the prostate. These include proctitis, diarrhea, bladder spasms, and urinary frequency. Internal radiation of the prostate almost always results in cystitis in the first 2 to 3 weeks of therapy. Encourage the patient to drink at least 2,000 ml of fluid daily. Administer analgesics and antispasmodics to increase comfort.

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing.

Androgen Deprivation therapy Luteinizing releasing-hormone agonist Flutamide(Eulexin) and nilutamide (Nilandron) Ketoconazole(Nizoral) and aminoglutethimide drugs Orchiectomy

Nursing intervention: After hormonal therapy

When a patient receives hormonal therapy with diethylstilbestrol, watch for adverse effects (gynecomastia, fluid retention, nausea, and vomiting). Be alert for thrombophlebitis (pain, tenderness, swelling, warmth, and redness in calf).

New types of treatment are being tested in clinical trials

Cryosurgery
Chemotherapy

Before surgery, discuss the expected results. Explain that radical surgery always produces impotence. Up to 7% of patients experience urinary incontinence. To help minimize incontinence, teach the patient how to do perineal exercises while he sits or stands. To develop his perineal muscles, tell him to squeeze his buttocks together and hold this position for a few seconds; then relax. He should repeat this exercise as frequently as ordered by the physician. Prepare the patient for postoperative procedures, such as dressing changes and intubation.

If appropriate, discuss the adverse effects of radiation therapy. All patients who receive pelvic radiation therapy will develop such symptoms as diarrhea, urinary frequency, nocturia, bladder spasms, rectal irritation, and tenesmus. Encourage the patient to maintain a lifestyle thats as nearly normal as possible during recovery.

Anxiety Urinary Retention Deficient Knowledge Imbalanced Nutrition Sexual Dysfunction Pain Impaired Physical Mobility and Activity Intolerance