Prostate Cancer

Front 1

What is prostate cancer?

Back 1

It's an androgen-dependent adenocarcinoma that is usually slow growing

Front 2

What is typical of younger men with prostate cancer?

Back 2

They usually have a more aggressive form

Front 3

What part of the body does prostate cancer

usually metastasize?

Back 3

To the bones, where it can be very painful

Front 4

What are risk factors for prostate cancer

Back 4

1. Age > 50

2. Ethnicity (more common in blacks)

3. Family history

4. Obesity

5. Diet high in red/processed meat, high-fat dairy

products and low intake of fruits/vegetables

Front 5

What are unclear risk factors for prostate

cancer?

Back 5

Smoking, BPH, lycopene, antioxidants; Vitamin E

intake showed an increased risk

Front 6

What are the 3 types of prostate cancer?

Back 6

1. Sporadic (most common); gene damage occurs by chance

2. Familial: 2+ first-degree relatives diagnosed; combination of genetics and environment

3. Hereditary (rare): gene mutations inherited

Front 7

What are the S/S of prostate cancer?

Back 7

- May be asymptomatic in early stages

- Similar to BPH (dysuria, dribbling, frequency,

urgency, hematuria, nocturia, retention

- Pain in lumbrosacral area that radiates to

legs and hips may show metastasis

Front 8

What are diagnostic studies for prostate cancer?

Back 8

1. PSA screen (but elevated levels may not

always mean cancer); also used to monitor

treatmen

2. DRE (PSA/DRE are not definitive for diagnosis)

3. Biopsy by TRUS is definitive diagnostic tool

4. Bone scan

5. CT

6. MRI

Front 9

What is the controversy of PSA screening?

Back 9

More men live and die with prostate cancer than those who die from it, so slow-growing cancers in older men may not be treated

Front 10

What factors can increase PSA levels?

Back 10

1. Aging

2. BPH

3. Recent ejaculation

4. Long bike rides causing acute/chronic

prostatitis

5. Cytoscopy

6. Indwelling catheter

7. Prostate biopsy

Front 11

What can decrease PSA levels?

Back 11

Meds such as finasteride and dutasteride

Front 12

When should PSA screenings be done?

Back 12

Yearly after age 50, but earlier for high-risk pts

(about age 40-45)

Front 13

If PSA levels are elevated, what may be done

before further testing?

Back 13

Give antibiotics to rule out infection

Front 14

How does the prostate feel during a DRE if the pt has cancer?

Back 14

Asymmetrical, hard and nodular

Front 15

What classification systems are most commonly used with prostate cancer?

Back 15

1. Tumor, node, metastasis (TNM)

2. Gleason scale of tumor histology

- Grade 1 is well differentiated, Grade 5 is

poorly differentiated

3. Gleason score (2-10)

4. Staging determined by combining TNM,

Gleason score and PSA level

Front 16

When is active surveillance/watchful waiting

appropriate for a pt with prostate cancer?

Back 16

1. Life expectancy < 10 years
2. Low grade, low stage tumor
3. Serious co-existing medical conditions

Front 17

When should the active surveillance approach be re-evaluated?

Back 17

If there are significant changes in PSA or DRE or development of further S/S

Front 18

What is a radical prostatectomy?

Back 18

Removal of the entire prostate, seminal vesicles and part of the bladder neck (ampulla)

- Retroperitoneal lymph node dissection usually

done in a separate surgery

Front 19

What are the 2 different types of radical

prostatectomy?

Back 19

1. Retropubic: low midline incision; pelvic

lymph nodes can be dissected

2. Perineal: incision made between scrotum

and anus (increased infection risk)

Front 20

What are newer surgical approaches for prostate cancer?

Back 20

1. Laparoscopic surgery

2. Robotic-assisted (da Vinci) surgery

3. Cryotherapy (freezing; may cause a fistula, damage the urethra, ED, incontinence,

prostatitis or hemorrhage)

Front 21

What are post-op concerns after prostate surgery?

Back 21

1. Pt has a large indwelling catheter with a

30 mL balloon

2. Pt has a drain; removed in a few days

3. Careful dressing changes, especially for

pt with perineal surgery

4. Hospital stay for 1-3 days

Front 22

What are 2 major adverse outcomes from a

radical prostatectomy?

Back 22

1. ED (depends on pt's age, pre-op sexual

function and type of surgery done); may

persist for up to 24 months as sexual

function gradually returns

2. Urinary incontinence: Kegels help

3. Other complications are hemorrhage,

urinary retention, infection, DVT, pulmonary

emboli, wound dehiscence

Front 23

When is a nerve-sparing procedure done with a radical prostatectomy?

Back 23

When the cancer is confined to the prostate and for men < 50 with good pre-op erectile function and low-stage prostate cancer; but no

guarantee that potency will be maintained

Front 24

What types of radiation therapy are done for

prostate cancer?

Back 24

1. External beam radiation: most common;

treated 5 days a week for 4-8 weeks; cure

rates comparable to surgery in pts with

localized cancer

2. Brachytherapy: radioactive seeds placed by

using TRUS, ultrasound and a grid template;

best for pts in early stages; more convenient

because it's a one-time treatment

Front 25

What are the adverse effects of external beam radiation?

Back 25

1. May be acute (< 90 days) or delayed (months or years); usually lessen in 2-3 wks

2. Skin changes (redness, dryness, irritation,

pain)

3. GI (diarrhea, ab cramping, bleeding)

4. Urinary tract (dysuria, frequency, hesitancy,

urgency, nocturia)

5. ED

6. Fatigue

Front 26

What are adverse effects of brachytherapy?

Back 26

1. Urinary irritative/obstructive problems

(most common)

2. ED

Front 27

How is androgen-deprivation therapy (ADT) used

to treat prostate cancer?

Back 27

It reduces the levels of circulating androgens to reduce tumor growth; can inhibit production (given IV or SQ) or block receptors (given PO)

Front 28

What are the problems with ADT?

Back 28

1. It becomes hormone refractory (resistant) in

a few years; usually indicated by elevated PSA

2. Increased risk of cardiovascular effects

- Elevated cholesterol, triglycerides; CAD

3. May increase risk of metabolic syndrome

4. Osteoporosis and fractures

Front 29

How does degarelix (ADT) treat prostate cancer and what are the adverse effects?

(Not on drug list, but I have a note from class to know the side effects because it's a newer drug)

Back 29

- Blocks LH receptors

- Immediate testosterone suppression

- May cause pain, redness and swelling at

injection site

- May cause elevated liver labs

Front 30

What drugs produce a chemical castration?

Back 30

Androgen synthesis inhibitors (a form of ADT); they produce effects similar to an orchiextomy

(removal of testes); given IM or SQ; causes a lot of pain at the injection site

Front 31

What are adverse effects of androgen synthesis inhibitors?

Back 31

Since they're similar to castration, they can cause gynomastia, decreased muscle mass and libido, ED, weight gain and hot flashes

Front 32

When is chemotherapy used to treat prostate cancer?

Back 32

Usually only in those with hormone-refractory prostate cancer (HRPC) in late stages; it's mainly palliative

Front 33

When is an bilateral orchiectomy (removal of the testes) done for prostate cancer?

Back 33

For advanced stages of cancer or for relief of bone pain; it may shrink the prostate and relieve

urinary obstruction

Front 34

What should be considered when treating African American men for prostate cancer?

Back 34

1. Higher mortality rates

2. Screenings not done due to lower

socioeconomic status

3. More problems with transportation, finances

and health care costs

4. White men perceived as getting better care

5. Use more religious coping strategies

6. Recommend PSA/DRE screenings starting at age 40-45

Front 35

What is the role of the RN in continuous bladder irrigation (CBI) after prostate surgery?

Back 35

1. Assess for bleeding, clots

2. Assess catheter patency and presence of

bladder spasms; measure I/O

3. Manually irrigate if bladder spasms or

decreased outflow

4. Discontinue CBI and notify MD if obstructed

5. Teach pt Kegel exercises

6. Provide cath care instruction to pt before

discharge

Front 36

What is the role of the LPN in continuous bladder irrigation (CBI) after prostate surgery?

Back 36

1. Monitor draining for increased blood/clots

2. Increase flow to maintain light pink color

3. Give antispasmotics and analgesics PRN

Front 37

What is the role of the UAP in continuous bladder irrigation (CBI) after prostate surgery?

Back 37

1. Clean around catheter daily

2. Record I/O

3. Notify RN if large amount of bright red blood in urine

4. Report complaints of pain/bladder spasm

Front 38

What are common problems with advanced prostate cancer?

Back 38

1. Fatigue

2. Bladder outlet obstruction R/T compression by the tumor

3. Severe bone pain/fractures

4. Leg edema R/T DVT, lymphedema

5. Spinal cord compression