Prostate Cancer Overview
Section snippets
Epidemiology and Risk
In 2010 approximately 217,730 new cases of prostate cancer were diagnosed in the United States, resulting in nearly 32,050 prostate cancer-related deaths.1
Approximately one in six men will be diagnosed with prostate cancer during his lifetime, and about one in 36 will die of prostate cancer.2 In the United States, prostate cancer decreased by 2.4% per year between 2000 and 2006 among all men. Deaths from prostate cancer decreased by 4.1% per year from 1994 to 2006 among all men.3
Advanced age is
Chemoprevention
There have been several trials studying the effects of 5-alpha-reductase inhibitors (5-ARI) on the prevention of prostate cancer. In the Prostate Cancer Prevention Trial, more than 18,000 men older than age 55 with a normal digital rectal exam (DRE) and PSA ≤3.0 ng/mL were randomized to placebo or finasteride 5 mg by mouth daily and followed for 7 years. Finasteride was found to decrease the risk of developing prostate cancer by 25%. None of the data proved that finasteride would not increase
Prostate Anatomy and PSA
The prostate gland is a partly glandular and muscular organ located within the lower pelvis directly below the internal urethral orifice and around the beginning of the urethra. The prostate, seminal vesicles, and bulbourethral glands are the accessory glands of reproduction.12 The primary function of the prostate is to secrete an alkaline fluid that forms part of the ejaculate, which aids in motility and nourishment of the sperm.13 The peripheral, central, transition, and fibromuscular zones
Clinical Presentation
Most patients with prostate cancer are asymptomatic, particularly in the early stages of disease. Lower urinary tract symptoms that are typically associated with BPH may also be present in men with prostate cancer, including weak stream, hesitancy, urgency, frequency, nocturia, straining, intermittency, incomplete emptying, and various degrees of incontinence.16 Men presenting with these symptoms should also be asked about hematuria, hematospermia, and erectile dysfunction (ED). A thorough
Diagnosis
Cancer that originates in glandular cells is called an ‘adenocarcinoma.’ Adenocarcinoma accounts for >95% of prostate cancers and arises from the prostate gland epithelial cells. The diagnosis of prostate cancer is accomplished by a histologic evaluation of prostate tissue sampled from a prostate needle biopsy. Transrectal ultrasound-guided needle biopsy is the most widely used method for obtaining prostatic tissue. The decision to perform prostate biopsy must be made between the practitioner
Staging
Prostate cancer staging is determined based on PSA value, DRE findings, prostate biopsy results, and Gleason score. Clinical staging refers to staging based on clinical findings such as PSA, DRE, and imaging. Pathologic staging is based on tissue diagnosis and relies on the TNM system developed by the American Joint Committee on Cancer (see Table 1).8 The system describes the extent of tumor [T], lymph node involvement [N], and presence of metastatic disease [M]. Each category is further
Treatment
Treatment options for men with prostate cancer vary based on staging. When choosing a treatment for an individual patient, the practitioner should consider the extent of disease, patient age, and competing co-morbidities. The National Comprehensive Cancer Network has published evidenced-based guidelines to aid in the decision-making process between patient and clinician.22 While the guidelines serve as a foundation, it is important that each patient be provided with an individualized treatment
Treatment for Advanced Prostate Cancer
Advanced prostate cancer refers to recurrent prostate cancer following definitive therapy, locally recurrent disease, systemic recurrence, or clinical (symptomatic) recurrence. Treatment for advanced prostate cancer includes hormone therapy, chemotherapy, and new emerging therapies.
Nursing Implications
With the advent of prostate cancer screening and a multitude of treatment options for men diagnosed with prostate cancer, patient education and psychosocial support becomes an important part of patient-centered care. Patients should be educated regarding screening recommendations and be offered evidence-based guidance. A thorough and thoughtful discussion about treatment options, from active surveillance to more aggressive modalities, should be arranged. Risks, benefits, and alternatives to all
Mary Weinstein Dunn, RN, MSN, OCN®, NP-C: Adult Nurse Practitioner, UNC Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Overview
Prostate cancer: risk factors, diagnosis, and management
Cancer Nur Pract
Transrectal ultrasound and biopsy in the early diagnosis of prostate cancer
Cancer Control
Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men
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Prostate cancer update
NP Journal
Cited by (0)
Mary Weinstein Dunn, RN, MSN, OCN®, NP-C: Adult Nurse Practitioner, UNC Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Meredith Wallace Kazer, PhD, APRN, A/GNP-BC, FAAN: Associate Professor and Graduate Program Director, Fairfield University, School of Nursing, Fairfield, CT.