Week 12 Neoplasm Male-AMAB Cancers Past Paper 2024-2025 PDF

Benign Prostate Hypertrophy a n d Prostate a n d Testicular Cancer Week 12 NURS1028 Chapter Note. "Please note that 57effort for more in an inclusive language, the content covered...

Benign Prostate Hypertrophy a n d Prostate a n d Testicular Cancer Week 12 NURS1028 Chapter Note. "Please note that 57effort for more in an inclusive language, the content covered refers to individuals assigned male at birth (AMAB) even though we may use the term "male" when discussing these reproductive cancers“. NURS 1028 / 2024-2025 1 Trans Women and Prostate Cancer Below are two links where individuals assigned male at birth had transitioned at female at some point in their life, but did not have bottom surgery, therefore have a prostate: Eve Gammill: She Found Out She Had Prostate Cancer https://zerocancer.org/zeronews/evegam mill/ Evie Longman: Trans Woman Dies of Cancer After Failing to Tell Doctor She Identified with Having a Prostate https://thestocktontimes.com/2018/07/19/ trans-woman-dies-of-cancer-after-failing-t o-tell-dr-she-identified-with-having-a-prost ate NURS 1028 / 2024-2025 2 Benign Prostatic 🠶 A benign enlargement of the prostate gland, is the most Hyperplasia c o m m o n urologic a l proble m in a d u lt males/AMAB 🠶 Noninfl ammatory enlargement of prostate gland resulting from hormonal changes associated with the aging process a n d a n increase in cells 🠶 Benign Prostatic “ H”… Hyp e rtrophy an d Hyp e rplasia are use d interchangeably, an d a formal dia g n o sis is required by bio p sy. A biopsy is a n invasive procedure a n d if a male/AMAB does not require a biopsy, it truly does not matter which term is used, it is assumed the male c lie nt has an e nlarged prostate 🠶 Hypertrophy refers to a n increase in cell size 🠶 Hyperplasia means a n increase in the number of cells The enlargement gradually compresses the urethra, eventually leading to partial or complete obstruction, therefore giving clinical symptoms BPH develops in the inner part of the prostate Most common urological problem in adult males/AMAB Occurs in 50% of males/AMAB over 50, and 80% of This Photo by Unknown Author is licensed under CC BY-SA-NC males/AMAB over 80 Approximately 25% will require treatment by age 80 Research is not clear about whether having BPH leads to an increased risk of NURS 1028 / 2024-2025 developing prostate cancer 3 Risk Factors 🠶 Aging 🠶 Most c o m m o n risk factor is aging. The risk of BPH increases with age, beginning at about a g e 40. The incidence increases with age—50% by a g e 50 a n d 80% by a g e 80. 🠶 Obesity (in particular, large waist circumference) 🠶 Increasing abdominal obesity a n d serum leptin l(hormone in adipose tissue) levels, which contributes to chronic elevation of insulin are associated with increased prostate volume 🠶 Lack of Physical Activity 🠶 Increases c ha nc e s of developing BPH, possibly be c a use exercise helps fight obesity, reduces inflammation, Type 2 Diabetes risk, insulin resistance, a n d other risk factors associated with BPH 🠶 Smoking 🠶 Nicotine is a major cause of inflammation a m o n g smokers 🠶 Diabetes 🠶 Components of Type 2 Diabetes (high glucose levels, insulin resistance), obesity increases the progression of BPH. Research indicates a relationship may b e due to elevated insulin levels, which not only gather blood sugar a n d help it into the cells, but also stimulate growth 🠶 Positive Family History 🠶 First-degree relatives, such as a father or brother, have b e e n diagnosed with BPH, there is a greater c h a n c e another individual in the family unit will also develop symptoms NURS 1028 / 2024-2025 4  Clinical 🠶Manifestations Symptoms usually gradual in onset 🠶 Early symptoms usually minimal because bladder c a n compensate 🠶 Worsen as obstruction increases 🠶 Symptoms categorized into two groups: 1. Obstructive Symptoms 🠶 Symptoms du e to urinary retention 🠶 Decrease in the calibre a n d force of the urinary stream, diffi culty in initiating voiding, intermittency (stopping a n d starting stream several times while voiding) and dribbling at the e nd of urination. 2. Irritative Symptoms 🠶 Symptoms associated with infl ammation or infection 🠶 Urinary frequency, urgency, dysuria, bladder pain, nocturia, a n d incontinence, are a ssocia te d with infla mma tio n o r infectio n. 🠶 Nocturia is often the first symptom that the client notices NURS 1028 / 2024-2025 5 Complicatio ns 🠶 Related to urinary obstruction 🠶 Acute urinary retention: c o m m o n complication is indication for surgical intervention 🠶 Urinary tract infec tion (UTI) a nd sep sis 🠶 Incomplete bladder emptying with residual urine provides medium for bacterial growth 🠶 Calculi ma y develop in bladder because of alkalinization of residual urine 🠶 Renal failure: caused by hydronephrosis 🠶 Pyelonephritis 🠶 Bladder d a m a g e NURS 1028 / 2024-2025 6 Diagnostic Studies 🠶 History and Physic al Examination 🠶 Primary methods used to diagnose BPH include a history a n d physical examination 🠶 Digital Rectal Examination (DRE) 🠶 Prostate c a n b e pa lpa ted by digital rectal examination (DRE) 🠶 Symmetrically enlarged, firm, a n d smooth 🠶 Urinalysis with C ulture 🠶 Determine the presence of infection or infl ammation 🠶 Prostate-Specific Antigen (PSA) Level 🠶 PSA test is no longer re c om m e nde d as the risks m a y outweigh the benefits 🠶 Used to monitor success of prostate c a n c e r treatment 🠶 Normal reference level 0-4.0 µg/L 🠶 Serum C reatinine This Photo by Unknown Author is licensed under CC BY-SA-NC 🠶 Rule out renal insuffi ciency NURS 1028 / 2024-2025 7 Diagnostic Studies 🠶 Transrectal Ultrasonography (TRUS) Scan 🠶 Indicated for clients with an abnormal DRE and elevated PSA, accurate assessment of prostate size and is helpful in differentiating BPH from prostate cancer 🠶 A transrectal ultrasound (TRUS) is a procedure which utilizes high-frequency sound waves, which are directed at the prostate gland a n d the echoes created by the sound waves will generate a n image of the prostate gland a n d surrounding tissue on a monitor for the physician to analyze for any abnormalities 🠶 The sca n req uires the insertion of a n ultrasound p robe into the c lie nt’ s rec tum 🠶 The probe then both sends a n d receives sound waves through the rectal wall into the prostate gla n d whic h is situate d direc tly in front of the rec tum 🠶 Procedure 🠶 A prostate ultrasound is typically performed as an outpatient procedure a n d usually takes about 15-30 minutes to complete. 🠶 Prior to the procedure, the client will b e asked to avoid aspirin for at least 7-10 days, as it c a n thin the blood. 🠶 O n e hour before the TRUS procedure, the client has to take an e n e m a to clean out the colon a n d urinate to empty their bladder as much as possible. 🠶 The client will wear a gown throughout the procedure a n d will b e asked to lay on their on their side with their knees bent close to their chest. 🠶 A protective cover is then p l a c e d on the ultrasound transducer (probe), lubricated a n d p l a c e d into the rectum. 🠶 The client may NURS 1028 feel a sensation of fullness or pressure in their rectum after the / 2024-2025 transducer is inserted. 8 🠶 Biopsies c a n b e taken during the ultrasonography procedure Diagnostic Studies 🠶 Uroflowmetry 🠶 Measures the volume of urine expelled from the bladder per sec ond, is helpful in dete rmining the extent of urethral bl o c ka ge a n d thus the type of treatment n e e d e d 🠶 The average flow rate for males/AMAB is 12 mL/sec ond 🠶 Postvoid residual urine volume is often measured to determine the degree of urine flow obstruction 🠶 Cystourethroscopy 🠶 Procedure allowing internal visualization of the urethra a n d the b la d d e r, is p e rform ed if the dia g n osis is un c e rtain a n d NURS 1028 / 2024-2025 This Photo by Unknown Author is licensed under CC BY-SA in clients scheduled for 9 prostatectomy Collaborative C a🠶 re 🠶 Collaborative Therapy: Active surveillance = “Watchful waiting” Restore bladder drainage 🠶 Relieve symptoms 🠶 Prevent a n d treat complications 🠶 Dietary changes 🠶 Timed voiding schedule 🠶 Drug Therapy: Offers Symptomatic Relief of BPH 🠶 5α-Reductase Inhibitors 🠶 Reduces the size of the prostate gland. Finasteride (Proscar) blocks the enzyme 5α- reductase, which is necessary for the conversion of testosterone a n d causes regression of hyperplastic tissue through suppression of androgens 🠶 α-adrenergic Receptor Blockers 🠶 Promote smooth muscle relaxation in the prostate, facilitating urinary flow through the urethra prazosin, doxazosin (Cardura) 🠶 Symptomatic relief of BPH, does not treat hyperplasia 🠶 Herbal Therapy 🠶 Saw Palmetto: Aff ect the metabolism of androgen a n d estrogen hormones to decrease prostate size NURS 1028 / 2024-2025 10 Collaborative C 🠶 a re Minimally Invasive Therapy 🠶 Transurethral Microwave Thermotherapy (TUMT) 🠶 Use of microwave radiating heat to produce coagulative necrosis of the prostate 🠶 Transurethral Needle Ablation (TUNA) 🠶 Low-wave radiofrequency used to heat the prostate, causing necrosis 🠶 Laser Prostatectomy 🠶 Use of a laser b e a m to cut or destroy part of the prostate 🠶 Intraprostatic Urethral stents 🠶 Insertion of self-expandable metallic stent into the urethra, where enlarged area of prostate occurs NURS 1028 / 2024-2025 1 1 Collaborative C a re 🠶 Invasive Therapy 🠶 Transurethral Resection of the Prostate (TURP) 🠶 Use of excision a n d cauterization to remove prostate tissue cystoscopically 🠶 Remains the standard for treatment of BPH 🠶 Transurethral Incision of the Prostate (TUIP) 🠶 Involves transurethral incisions into prostatic tissue to relieve obstruction 🠶 Eff ective for clients with small to moderate sized prostates 🠶 Prostatectomy 🠶 Surgery NURS of c1028 h o/ 2024-2025 i c e for clients with large sized prostates, bladder 1 da m a g e , or other complicating factors A ssessme nt Subjective Data 🠶 Past Health History: Family history of BPH; obesity; diet high in fat or zinc 🠶 Medications: Estrogen or testosterone supplementation 🠶 Surgeries or Other Treatments: Previous treatment for BPH 🠶 Symptoms: 🠶 Voluntary fluid restriction 🠶 Urinary urgency, dysuria, retention; diminution in calibre a n d force of urinary stream; hesitancy in initiating voiding; postvoiding dribbling; incontinence; nocturia; bladder discomfort; anxiety about sexual functioning Objective Data 🠶 Digital Rectal Examination: NURS 1028 / 2024-2025 Distended bladder on palpation; smooth, firm, elastic enlargement of prostate 13 Nursing Diagnoses 🠶 Ac u t e pain related to biological injury a g e n t (bladder distention secondary to enlarged prostate) Example: Acute pain related to bladder distention as evidenced by client stating, “I have had a decrease in the force of my urine, diffi culty in starting my stream. I fi nd I stop and start my stream several times and then I dribble at the end of urinating on my underwear’. 🠶 Risk for infection as e v i d e n c e d by insuffi cient knowledge to a v o i d pathogens, stasis of b o d y fluid (indwelling catheter, urinary stasis) 🠶 Urinary retention related to urethral obstruction secondary to prostate enlargement or tumour NURS 1028 / 2024-2025 14 Plannin g 🠶 Preoperative Goals 🠶 The overall preoperative goals for clients having invasive procedures are: 🠶 restoration of urinary drainage 🠶 treatment of any UTI 🠶 a n understanding of the upcoming procedure, the implications for sexual functioning, a n d urinary control 🠶 Postoperative Goals 🠶 The overall postoperative goals are: 🠶 no complications 🠶 restoration of urinary control 🠶 complete bladder emptying 🠶 the ability for satisfying sexual expression NURS 1028 / 2024-2025 1 5 Nursing Interventions 🠶 Acute Intervention (Preoperative) 🠶 Urinary Drainage Must be Restored 🠶 A urethral catheter such as a c o u d é (curved-tip) catheter may b e n e e d e d to restore drainage 🠶 10 mL of sterile 2% lidocaine gel is injected into the urethra before insertion of the catheter 🠶 Infection of the Urinary Tract Must be Treated 🠶 Antibiotics are usually administered before any invasive procedure 🠶 Encouraging a high fluid intake (2 to 3 L/day unless contraindicated) 🠶 Impact of Surgery on Sexual Functioning 🠶 Clients a n d their partners should b e provided an opportunity to express their concerns 🠶 Sexual counselling a n d treatment options may b e necessary if ED b ecomes a chronic or permanent problem 🠶 M a y ta ke up to 1 ye a r fo r c o m p le te se xua l func tio ning to re turn 🠶 Retrograde ejaculation; should know that the amount of ejaculate may decreaseNURS or 1028 b e / 2024-2025 totally absent 16 🠶 Orgasmic sensations felt during ejaculation may decrease. Retrograde Nursing Interventions 🠶 Ac ute Intervention (Postoperative) 🠶 Catheter and Irrigation 🠶 Client will have a triple-lumen catheter (irrigation solution flows into bladder through one port a n d out of the bladder through another port into the urinary drainage bag) 🠶 Bladder irrigation removes clotted blood from the bladder and ensures drainage of urine 🠶 Bladder is irrigated by CBI with sterile normal saline solution or another prescribed solution 🠶 Infusion and Output (Inflow and Outflow) 🠶 Rate of infusion is based on the colour of drainage 🠶 Urine drainage should b e light pink without clots 🠶 Inflow a n d outflow of irrigation must b e continuously monitored 🠶 Outflow is less than inflow, the bladder should be assessed immediately, and the catheter patency checked (+ output balance) 🠶 Outfl ow is blocked, CBI must b e stopped, a n d the health care provider notified NURS 1028 / 2024-2025 17 Nursing Interventions 🠶 Ac ute Intervention (Postoperative) 🠶 Blood Clots 🠶 Blood clots are ex pe cted for the first 24 to 36 hours after prostate surgery 🠶 Large amounts of bright-red blood in the urine c a n indicate hemorrhage 🠶 Bladder Spasms 🠶 Bladder spasms are a distressing complication for clients after transurethral procedures 🠶 Result of irritation of the bladder mucosa from the insertion of the resectoscope, presence of a catheter, or clots leading to obstruction of the catheter 🠶 Catheter should b e c h e c ke d for clots a n d removed by irrigation so that urine c a n flow freely 🠶 Antispasmodics NURS 1028 / 2024-2025 (e.g., belladonna a n d opium suppositories, oxybutynin [Oxytrol]), along with relaxation techniques, are used 18 to relieve the pain a n d decrease spasm Nursing Interventions 🠶 Ac 🠶 ute Intervention Catheter and Postoperative Voiding (Postoperative) 🠶 Catheter is often removed 2 to 4 days after surgery 🠶 Client should void within 6 hours after catheter removal 🠶 If client cannot void, a catheter is reinserted for a d a y or two 🠶 If problem continues, nurse ma y n e e d to instruct the client about clea n intermittent self-c a theterization 🠶 Sphincter Tone 🠶 Sphincter tone ma y b e poor immediately after catheter removal, resulting in urinary incontinence or dribbling. 🠶 Sphincter tone c a n b e strengthened with Kegel exercises (pelvic floor muscle tech niq ue) p rac tised 10 to 20 tim es p er hour while a w a ke 🠶 Clients should b e encour a ged to practise starting a n d stopping the stream NURS 1028 / 2024-2025 several times during urination 19 Transurethral Resection of the Prostate (TURP) Summary Information TURPS 🠶 Tubes 🠶 Urinary output/outflow 🠶 Red drainage 🠶 Pieces of clots 🠶 Spasms NURS 1028 / 2024-2025 20  CBI 🠶Calculation Alex h a d a TURP 24 hours a g o 🠶 At the e n d of the shift, the practical nurse is documenting their inflow a n d outflow: 🠶 Every 4 hours during a 12-hour d a y shift, the practical nurse hangs a new 3000 mL N/S irrigation b a g and, also empties the Foley catheter drainage bag. 🠶 1100 hours = 3400 m l is em ptied 🠶 1500 hours = 2800 m l is em ptied 🠶 1900 hours = 3575 m l is em ptied 🠶 What is Alex’s total true urinary output/ouflow for the 12-hour day shift? 🠶 Answer: +775 ml (Refer to next slide as to understand how that was calculated) 🠶 What would the practical nurse expect the colour of the fluid to be in the client’s catheter drainage tubing? 🠶 Answer: Light pink (24 hours post-op) NURS 1028 / 2024-2025 2 1 CBI Calculation (Should Know How to Calculate CBI Output/Oufl ow) Time Continuous Bladder Irrigation Bag (CBI) Output/Outlflow (Between True (inflow) CBI and Urinary Output Urine Bag) Output 0700 Received 3000 ml b a g hung by night shift N/A N/A This CBI bag is counted as Bag#1 1100 At 1100, the 3000 ml b a g that was hung at CBI Bag #1 (0700-1100) +400 ml 0700 was infused a n d 3400 ml was emptied into the cannister 3400 ml -3000 ml This CBI bag is counted as Bag#2 True Urine Output +400 ml 1500 At 1500, the 3000 ml b a g that was hung at CBI Bag #2 (1100-1500) -200 ml 1100 was infused a n d 2800 ml was emptied into the cannister 2800 ml– 3000 ml This CBI bag is counted as Bag#3 True Urine Output -200 ml 1900 At 1900, the 3000 ml b a g that was hung at CBI Bag #3 (1500-1900) +575 ml 1500 was infused a n d 3575 ml was emptied into the cannister 3575 ml – 3000 ml This CBI b a g is counted as Bag#1 (for night True Urine Output +575 ml shift) True Total Urine Output +775 ml for 12 hour Day Shift What happened to 200 ml of urine between 1100 and 1500 hours that gave a negative balance? 1. Assess to see if the client is having bladder spasms, they may b e retaining urine in the bladder. 2. C h e c k for leaking onto the blue p a d or soaker p a d under the client. When the bladder has spasms or the tip of the catheter inside the client’s bladder gets blocked by residual blood clots from the surgery, urine c a n leak around the meatus of the penis. 3. If the padding under the client is d a m p or wet, ask the client if they are feeling spasms a n d look at the clear tubing of the catheter b a g to see if there are bubbles moving up a n d down…that is an indication of a bladder spasms. 4. When all else fails, ask colleagues if anyone emptied the Foley catheter b a g while covering for any 22 breaks an dNURS 1028 lunc h,/ 2024-2025 dinner, etc. Nursing Interventions 🠶 Health Promotion 🠶 Health promotion focuses on early detection a n d treatment 🠶 Yearly medical history a n d DRE for males/AMAB over 50 years of a g e 🠶 Re d u c e caff eine a n d alcohol = Diuretic eff ect a n d bladder distention 🠶 Encourage clients to urinate every 2 to 3 hours a n d when first feeling the urge 🠶 Fluid intake maintained at a normal level to prevent fluid restriction (dehydration) or overload NURS 1028 / 2024-2025 2021-2022 🠶 Fluid restriction = Infe c tion 23 Nursing Interventions 🠶 Ambulatory and Home Care 🠶 Discharge planning a n d home ca re issues are: 🠶 Bladder may take up to 2 months to return to its normal c a p a c i t y 🠶 Clients should b e observed for signs of postoperative infection 🠶 Avoid or limit the intake of bladder irritants such as caff eine products, citrus juices, and alcohol 🠶 Caring for a n in-dwelling catheter (if o ne is left in place) 🠶 M anagi ng urinary incontinence by urinating every 2 to 3 hours 🠶 Maintaining oral fluids between 2 000 a n d 3 000 mL/day to flush the urinary tract 🠶 Observing for signs a n d symptoms of UTI a n d wound infection 🠶 Preventing constipation by increasing fluids a n d high fiber diet 🠶 Rectal procedures, such as taking rectal temperatures a n d administering enemas, should be avoided 🠶 Avoiding he a v y lifting (>4.5 kg) 🠶 Refraining from driving or having intercourse after surgery as directed by the physician 🠶 Continence c a n improve for up to 12 months 🠶 If continence has not be e n achie ve d by that time, clients m a y b e referred to a continence clinic 🠶 Highly encourage watching this video: https://www.youtube.com/watch?v=9wGZ7Yj NURS 1028 / 2024-2025 24 uaFA  Prostate 🠶 M aligna n t tumour of prostate Cancer 🠶 Prostate c a n c e r is a n androgen-dependent a de no ca rci no m a that is usually slow growing 🠶 Develops in the outer part of the prostate 🠶 It is the most c o m m o n male/AMAB cancer, excluding skin c a n c e r 🠶 1 in 7 males/AMAB will develop prostate c a n c e r during their lifetime 🠶 75% of c ases o c c ur in males/AMAB > 65 🠶 M a n y cases c a n occur in younger individuals, who sometimes ha ve a more aggressive type of c a n c e r 🠶 Prostate c a n c e r later spreads through the lymphatic system to the regional lymph nodes 🠶 The veins from the prostate seem to b e the m o d e of spread to the pelvic bones, the h e a d of the femur, the lower lumbar spine, the liver, a n d the lungs This Photo by Unknown Author is licensed under CC BY-NC-ND NURS 1028 / 2024-2025 25 Risk Factors 🠶 Age: Risk increases a s m a l e s / A M A B g row o ld er 🠶 Race: Rates are two times higher in African C a n a d i a n descent m a l e s / A M A B than in Caucasian 🠶 Family History: First degree relative(s) with prostate c a n c e r doubles the risk (i.e., father/brother) 🠶 The BRCA2 gene, which is linked with breast cancer, is also linked with prostate c a n c e r 🠶 Hormones: Testosterone helps the c a n c e r cells to grow 🠶 Chemicals: Occupational exposure to chemical carcinogens such as insecticides, cadmium, or rubber manufacturing 🠶 Diet: High fat diet, eating red meat (e.g., beef, pork) c o o ke d at high temperatures, processed meat (e.g., b a c o n , hot d o g s) and d a iry (c a lcium is linked to prosta te cancer) NURS 1028 / 2024-2025 26 Risk Factors High Fat Diet  The study found that “when prostate cancers lose a particular gene, they become tiny fat factories.” The study, done on mice, found that without this gene prostate cancer spread and metastasized when fed a high-fat diet  This preliminary finding suggested dietary fat can fuel prostate cancer growth. The investigators also used an obesity drug that blocks fat production resulting in a regression of metastatic prostate cancer in mice  The next step involves designing a clinical trial for men with prostate cancer to see if the obesity drug may be an aid to treatment for this cancer Red Meat  A diet high in red meat may be associated with an increased risk of prostate cancer, and a substance called heterocyclic amines (HCAs) is partly to blame  Heterocyclic amines are chemicals formed when muscle meat (including beef, pork, fish, and poultry) is cooked using high-temperature methods, such as pan frying or grilling directly over an open flame.  In laboratory experiments, HCAs have been found to be mutagenic, meaning that they can cause changes in DNA that may increase the risk of cancer: When grilling, avoid direct exposure of meat to an open flame or a hot metal surface and avoid prolonged cooking at high temperatures Use a microwave oven to cook meat prior to exposure to high temperatures Frequently turn meat over on a high heat source Always remove charred portions on meat and refrain from using gravy made from meat drippings Dairy and Calcium  A high calcium intake, mainly from dairy products, may increase prostate cancer risk by lowering concentrations of 1,25-dihydroxyvitamin D 3 a hormone thought to protect against prostate cancer NURS 1028 / 2024-2025 27 Clinical Manifestations 🠶 Usually asymptomatic in early stages 🠶 Eventually the client ma y experience symptoms similar to BPH: 🠶 Dysuria 🠶 Hesitancy 🠶 Dribbling 🠶 Frequency 🠶 Urgency 🠶 Hematuria 🠶 Nocturia 🠶 Retention 🠶 Interruption of urinary stream 🠶 In a b ility to urin a te 🠶 Pelvic pain or pressure (malignant tumour growth) is the one main symptom distinguishing the difference from BPH. Also, consider pain in lumbosac ral area that radiates to hips or legs, when coupled with urinary symptoms, could indicate metastasis 🠶 O n c e the ca NURSn cer 1028 has spread to distant sites, pain / 2024-2025 management beco mes the major problem 2 8  Diagnostic 🠶Studies Primary Screening Tool 🠶 DRE (Digital Rectal Examination) 🠶 Ab normal p rostate find ings: hard, no du lar, a n d asymme tric al 🠶 Other Sc reening Tools 🠶 PSA (Prostate-Specific Antigen) Blood Test 🠶 PSA test is no longer reco m mended as the risks may outweigh the benefits 🠶 Used to monitor success of treatment 🠶 When treatment for prostate c a n c e r has b e e n successful, PSA levels should fall to undetectable levels 🠶 Note. Neither a PSA or DRE is a definitive diagnostic test 🠶 Prostatic Acid Phosphatase (PAP) 🠶 Elevated levels of prostatic isoenzyme of serum a c i d phosphatase (prostatic a c i d p hosphatase [PAP]) also ind ic ate p rostate c a n c e r 🠶 Ad v a n c e d prostate cancer, serum alkaline phosphatase is increased as a result NURS of 1028 / 2024-2025 29 b o n e metastasis  Diagnostic 🠶 Studies Prostate C ancer Associated 3 (PCA3) 🠶 Recent development in the diagnosis of prostate c a n c e r is the discovery of this gene, whic h is spec ific to prostate c a n c e r c e lls a n d, if present in the urine , ind ic a te s prostate c a n c e r 🠶 PCA3 test is more a ccura te than the PSA test beca use benign enlargement of the prostate will not cause a n increase in PCA3, whereas it c a n cause a n increase in the PSA test 🠶 Biopsy of Prostate Tissue 🠶 Done using transrectal ultrasound (TRUS) to allow physician to visualize a n d pinpoint abnormalities by using high-frequency sound waves to create a n image of the prostate gland a n d the surrounding tissue 🠶 Biopsy needle is inserted into the prostate to obtain a tissue sample 🠶 Pathological examination of the specimen is d o n e to assess for malignant changes 🠶 Bone, CT scans and MRI (using a n endorectal probe) 🠶 Complete d o n c e a diagnosis of prostate c a n c e r is confi rmed, used to ev a lua te for m etastatic disease NURS 1028 / 2024-2025 3 0  Collaborative 🠶 CActive a re Surveillance 🠶Early diagnosis is important a n d regular health scre e ning is critic a l 🠶 Conservative Therapy 🠶Watchful waiting with annual physical exam including DRE when: 🠶 Life exp e c t a n c y is less than 10 years 🠶Presence of significant co-morbid disease 🠶Presence of low-grade, low-stage tumour 🠶 A significant c h a n g e in DRE or the development of symptoms warrants a re- evaluation of treatment options NURS 1028 / 2024-2025 3 1 Collaborative C a re 🠶 Surgery 🠶 Radic a l p rostate ct o my 🠶 Nerve-sparing procedure 🠶 C ryotherap y 🠶 O rchie ctom y (for me tastatic disease) 🠶 Radiation Therapy 🠶 External b e a m for primary, adjuvant, a n d recurrent disease 🠶 M o s t widely used method of radiation for prostate c a n c e r 🠶 Bra c h y thera p y 🠶 Drug Therapy 🠶 Andro g e n d e privatio n thera p y 🠶 C hem otherap y for meta static disease NURS 1028 / 2024-2025 32 Surgical Therapy Radical Prostatectomy 🠶 Entire prostate gland, the seminal vesicles, a n d part of the bladder neck (ampulla) are surgically removed 🠶 V ery va scular a rea a nd high risk of hemorrhaging c a n occur, therefore monitor vital signs a n d c h e c k dressing sites frequently 🠶 Retrop eriton e a l lym p h node dissectio n is usua lly done as a separate procedure 🠶 Retropubic: Low midline abdominal incision is m a d e to access the prostate gland, a n d the pelvic lymph nodes then c a n b e dissected 🠶 Perineal Resection: Incision is m a d e between the scrotum a n d the anus 🠶 Note. Surgery is usually not c o nsidered a n o p tio n for a d v a n c e d stage disease (except to relieve symptoms NURS 1028 /associated 2024-2025 with obstruction) beca use metastasis has 33 Surgical Therapy Radical Prostatectomy Post-Operative Care 🠶 Urinary Elimination 🠶 Client will have a large in-dwelling catheter with a 30-mL balloon p l a c e d in the bladder via the urethra 🠶 This catheter is typically left in p l a c e for 1 to 2 weeks 🠶 Monitor for obstructed catheter 🠶 Maintain fluid b a l a n c e 🠶 Wound Care 🠶 Pain management (i.e., P C A pump) 🠶 A drain is left in the surgical site to aid in the removal of drainage from the area 🠶 Dra in is typ ic a lly rem ove d a fter a p p roxima tely two d a ys 🠶 Careful dressing changes and perineal care after each bowel movement are important to promote comfort and prevent infection 🠶 Rationale: Perineal approach has a higher risk for postoperative infection (owing to the loc ation of the incision related to the anus) 🠶 Discharge Date 🠶 Depending NURSon 1028 the type of surgery, the length of hospital stay / 2024-2025 34  Surgical 🠶 Nerve-Sparing Procedure Therapy 🠶 In proximity to the prostate gland are neuro-vascular bundles that m aintain erectile func tioning 🠶 Purpose of the surgery is to preserve these bundles during a prostatectomy is possible while still removing all of the c an c e r 🠶 Risk for erectile dysfunction is significantly re duced with this procedure…no guarantee that potency will b e maintained 🠶 Most mal e s/ AMAB younger than 50 years with g o o d preoperative erectile function a n d low-stage prostate c a n c e r c a n expect a return of potency after nerve- sparing prostatectomy 🠶 Cryosurgery 🠶 Surgical technique for prostate c an c e r that destroys c an c e r cells by freezing the tissue 🠶 Used both as an initial treatment a n d as a second-line treatment after radiation treatment failures. 🠶 A TRUS probe is inserted to visualize the prostate gland 🠶 Probes containing liquid nitrogen are then inserted into the prostate 🠶 Liquid nitrogen delivers freezing temperatures, destroying the tissue 🠶 The treatment takes about 2 hours under general or spinal anaesthesia a n d does not involve an abdominal incision NURS 1028 / 2024-2025 35 🠶 Complications: D a m a g e to the urethra, a urethro-rectal fistula  Radiation 🠶 Therapy External Beam Irradiation 🠶 C o m m o n treatment option for prostate cancer, especially for individuals older than 70, clients who are poor surgical risks, or those who wish to avoid surgery 🠶 Outpatient basis 5 days a week for 4 to 8 weeks 🠶 Each treatment lasts only a few minutes 🠶 Brachytherapy 🠶 Best suited for clients with early-stage prostate cancer 🠶 Implantation of radioactive seeds into the prostate gland, allowing higher radiation doses directly in the tissue while sparing the surrounding tissue (rectum a n d bladder) 🠶 Radioactive seeds are p l a c e d in the prostate gland with a needle through a grid template guided by TRUS 🠶 One-time outpatient procedure, many clients find it more convenient NURS 1028 / 2024-2025 than external b e a m radiation treatment 3 6 Drug Therapy 🠶 Androgen Synthesis Inhibitors 🠶 Luteinizing hormone-releasing hormone (LHRH) agonists (also called GnRH agonists) 🠶 These medications essentially produce a chemical castration similar to the eff ects of a n orchiectomy 🠶 Administered by subcutaneous or intramuscular injections on a regular basis, a n d they must b e taken indefinitely 🠶 Androgen Receptor Blockers 🠶 Anti-androgens are drugs that bind to these receptors so the androgens cannot stop them from aff ecting prostate c a n c e r cells 🠶 Orchiectomy 🠶 Bilateral orchiectomy is the surgical removal of the testes (surgical castration) that ma y b e done alone or in combination with prostatectomy. 🠶 C a n c e r control in clients in a n a d v a n c e d stage of prostate c a n c e r 🠶 Chemotherapy: G o a l of chemotherapy is mainly NURS 1028 / 2024-2025 palliation 3 7 A ssessme nt Subjective Data 🠶 Past Health History: Family history of prostate c a n c e r ; diet high in fat 🠶 Medications: Use of testosterone supplements or a n y other medications aff ecting urinary tract (i.e., morphine, anticholinergics, monoamine oxidase inhibitors, a n d tricyclic antidepressants) 🠶 Surgeries or Other Treatments: History of urinary tract infections or prostate problems Objective Data 🠶 Symptoms: Urinary hesitancy; urgency or frequency; retention with dribbling; low b a c k pain; anorexia; fatigue; anxiety 🠶 Findings: Distended bladder; enlarged, fixed NURS 1028 / 2024-2025 prostate; 3 pathological fractures 8 Nursing Diagnoses 🠶 Decisional conflict related to confl icting information sources, inexperience with decision-making (numerous alternative treatment options) 🠶 Acute pain related to biological injury agent, physical injury agent (prostatic enlargement, surgery) 🠶 Impaired urinary elimination related to multiple causality (obstruction of the urethra by the prostate, loss of bladder tone) 🠶 Sexual dysfunction related to vulnerability (effects of treatment) 🠶 Anxiety related to threat to current status, threat of death (eff ect of treatment on sexual function, 39 NURS 1028 / 2024-2025 uncertain outcome of disease process) Plannin gOverall goals for the client will: 🠶 b e active participant in therapeutic plan 🠶 h a v e satisfactory pain control 🠶follow therapeutic plan on sexual dysfunction 🠶understand the eff ect of the therapeutic plan on sexual function 🠶 fi n d a satisfactory way to m a n a g e impact on bladder or bowel function NURS 1028 / 2024-2025 4 0 Nursing Interventions Health Promotion 🠶 Encourage clients to have annual health checkups, including a DRE, starting at a g e 50 (or younger if risk factors are present) Acute Intervention 🠶 Preoperative a n d postoperative care of radical prostatectomy 🠶 Sensitive, caring support for client a n d family (e.g., seeking information other treatment for sexual dysfunction) 🠶 Enc o ura g e joining a sup p o rt g ro up Ambulatory and Home Care 🠶 Avoid straining- stool softeners as needed, no lifting 🠶 Avoid enemas, rectal tubes a n d rectal temperatures d ue to proximity of surgical site 🠶 C atheter C are for Indwelling C atheters 🠶 Cl ean the urethral meatus with soap a n d water o n c e a day; maintain a high fluid intake; keep the collecting b a g lower than the bladder at all times; keep the catheter securely anchored to the inner thigh or the abdomen; a n d report any signs of bladder infection, such as bladder spasms, fever, or hematuria 🠶 Incontinence 🠶 Encouraged to practise pelvic floor muscle exercises (Kegel exercises) at every urination a n d thro ug ho ut the d a y to help streng then p elvic flo o r m usc les NURS 1028 / 2024-2025 4 1 Nursing Interventions Discharge Teaching 🠶 Palliative and End-of-life Care with Advanced Prostate Cancer 🠶 C o m m o n problems experienced by clients with a d v a n c e d prostate c a n c e r include: 🠶 Fatigue 🠶 Constipation 🠶 Bladder outlet obstruction a n d ureteral obstruction (caused by compression of the urethra or ureters or both from tumour mass or lymph n o d e metastasis) 🠶 Severe b o n e pain a n d fractures (caused by b o n e metastasis) 🠶 Spinal cord compression (from spinal metastasis) 🠶 Leg e d e m a (caused by lymphedema, deep-vein thrombosis, or another medical condition) 🠶 Nursing interventions must focus on all of these problems 🠶 M a na gem e nt of pain is one of the most important aspects of nursing c a re for these clients 🠶 Ongoing pain assessment, administration of prescribed medications (both opioid and nonopioid agents), and nonpharmacological methods of pain relief (e.g., relaxation breathing), therefore place the client on a bowel routine as constipation NURS 1028 / 2024-2025puts added pressure onto the bowel 4 2 Prostate C a n c e r Client Testimonials 🠶 https://www.youtube.com/watch?v=GMQVAb-gw Co 🠶 This client m a d e this video clip emotional to watch NURS 1028 / 2024-2025 43  Testicular 🠶 C a n occur most often between a g e 15 a n d 40 years Cancer 🠶 Most c o m m o n c a n c e r in males/AMAB a n d adolescents 15 to 29 years of a g e 🠶 O n e of the most highly curable forms of c a n c e r in C a n a d a 🠶 If found a n d treated early there is a 97% complete remissio n a n d 96% lo ng term (5 year) survival rate This Photo by Unknown Author is licensed under CC BY-SA NURS 1028 / 2024-2025 44 4 4 Risk Factors 🠶 Undescended testicles (cryptorchidism) is one of the main risk factors for testicular cancer 🠶 Orchitis 🠶 Klinefelter's syndrome (XXY) 🠶 Po sitive fam ily histo ry 🠶 C a n c e r of one testicle (has a greater c h a n c e of developing subsequent tumours) 🠶 Ra c e a n d ethnicity 🠶 White C a n a d i a n males/AMAB ha ve a five times greater risk than that of black C a n a dia n males/AMAB a nd m ore th a n doub le the risk o f A sia n C a n a dia n males/AMAB 🠶 Occupational hazards (i.e., exposure to chemicals encountered in mining, oil a n d gas production 🠶 Mining: Exposure to zinc a n d cadmium, which are Group 1 carcinogens 🠶 Oil a n d G a g Production: Exposure to benzene, which is a NURS 1028 / 2024-2025 carcinogen 45 chemical Clinical Manifestations 🠶 Testicular c a n c e r may have a slow or rapid onset depending on the type of tumour 🠶 Painless lump in the scrotum, as well as scrotal swelling a n d a feeling of heaviness 🠶 Scrotal mass usually is nontender a n d very firm 🠶 Dull a c h e or heavy sensation in the lower abdomen, the perianal area, or the scrotum 🠶 Acute pain is the presenting symptom in about 10% of clients 🠶 Metastatic Disease: Lower b a c k or chest pain, cough, a n d dyspnea NURS 1028 / 2024-2025 46 Diagnostic Studies 🠶 History and Physical 🠶 Palpation of the scrotal contents is the first step in diagnosing testicular cancer 🠶 A cancerous mass is firm a n d does not transilluminate 🠶 Testicular Ultrasound 🠶 Indicated whenever testicular c a n c e r is suspected (e.g., palpable mass) or when persistent or painful testicular swelling is present 🠶 Lab Tests 🠶 High levels of certain proteins such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), a n d enzymes like lactate dehydrogenase (LDH) 🠶 These markers may help find a tumour that is too small to b e felt during a physical creating a small incision in the skin of the scrotum. A small p i e c e of the removed examination through testicle tissue is the incision by snipping the sample off with small scissors 🠶 Testicular 🠶 Metastatic Disease Biopsy 🠶 🠶 Chest A radiograph small 🠶 CTportion Scan of the a b d o m e n a n d pelvis of testicle is 🠶 C B C (Hgb for anemia) removed for 🠶 Liver function tests examination. The biopsy is NURS 1028 / 2024-2025 47 Nursing a n d Collaborative M a nular Testic a ge ment Self-Examination 🠶 The following instructions when teaching a client how to perform testicular self-examination (starting at a g a 🠶1. Just after e shower 15): or bath is the best time to examine the testes. Warm temperatures make the testes hang lower in the scrotum 🠶2. Stand in front of a mirror. Look for any swelling on the skin of the scrotum 🠶3. Hold your scrotum in the palms of your hands so that you c a n fee l the size a n d w eight of e a c h te stic le. It is normal for o ne testicle to b e larger a n d hang lower than the other 🠶4. Gently roll e a c h testicle between your thumb a n d your fingers. Feel for lumps or bumps. If you feel a soft, tender tube cord leading upward from the b a c k of e a c h testicle, that is normal 🠶 5. Notify the health ca re provider at o n c e if any a b normalitie s are found 🠶 Videotapes a n d illustrations on shower hangers are available as teaching aids a n d ideally should b e introduced during high school or college physical education classes 🠶 Free information is available through the C a n a d i a n C a n c e r Society a n d on various medical websites NURS 1028 / 2024-2025 48  Collaborative 🠶COrchiectomy a re or a radical orchiectomy (surgical removal of the aff ected testis, the spermatic cord, a n d regional lymph nodes) 🠶 Unilateral Orchiectomy: Removal of a testis does not necessarily aff ect hormone levels or virility 🠶 Post-orchiectomy treatment involves surveillance, radiation therapy, or chemotherapy, depending on the stage of the cancer: 🠶 Stage 1: Ra d ic a l Ing uina l Orc hie c tom y 🠶 If both testicles are removed, a man will have no ability to produce sperm cells a n d will b e c o m e infertile (unable to father a child) 🠶 Removal of a testis does not necessarily aff ect hormone levels or virility 🠶 Bilateral orchiectomy requires hormone replacement or testosterone 🠶 Retroperitoneal lymph n o d e dissection (open or laparoscopic) to prevent lymphatic spread of/ 2024-2025 NURS 1028 the c a n c e r 4 9 Collaborative C Stage 🠶 a re2: C h e m otherap y (Sta g e 2C) 🠶 Stage 3: Both chemotherapy a n d external (not brachytherapy) radiation therapy (when disease does not respond to chemotherapy) 🠶 Radiation is only delivered to the aff ected side to shield the remaining testis from radiation a n d preserve fertility 🠶 Meticulous follow-up a n d regular physical examinations, chest radiographic examinations, CT scans, a n d assessment of human chorionic gonadotropin a n d alpha-fetoprotein 🠶 Gel-filled silicone prosthesis c a n usually b e surgically implanted into the scrotum at the time or later (same as individuals having breast implants for cancer. 🠶 Discuss fertility a n d sperm banking before any treatment 🠶 Sensitive to any psychosocial problems on a man's feelings of self-worth or sexual performance 🠶 Note. Treatment has the potential to interfere with both NURS 1028 / 2024-2025 50 erections a n d References Tyerman, J., Cobbett, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022). Lewis’s medical- surgical nursing in Canada: Assessment and management of clinical problems (5th Canadian ed.). Elsevier Canada. NURS 1028 / 2024-2025 51