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Flashcards in prostate cancer Deck (24):
1

Prostate cancer etiology

Leading cause of cancer in men (affects 1 in 5 men)
2nd leading cause of cancer death in men
Cancer rates twice as high in blacks as opposed to whites
–Common in N. America and Northwest Europe
–Rare in Asia and S. America

2

Prostate cancer risk factors

1. Age- 70% diagnosed in men > age 65
2. Hormonal influences- men castrated before puberty are at little risk
3. Familial predisposition- (5-10% of cases)
4. Increased dietary fat
5. Viral cause: CMV (cytomegalovirus) and Herpes more common in cancerous prostatic tissue
6. Increased STDs, multiple sex partners, exposure to heavy metals (cadmium)

3

prostate cancer patho

95% of tumors are adenocarcinomas
Begins as discrete, localize hard nodule, often on periphery of gland of posterior lobe
Slow growing
Follows predictable pattern of metastases:
1.Prostatic nodes, to Pelvic nodes, to Bone Marrow, to bone of pelvis, sacrum, and lumbar spine
2. Late stages: lung, liver, adrenals, kidneys

4

prostate cancer diagnostics

digital rectal exam
PSA- prostate Specific antigen
Transrectal Ultrasound
biopsy confirms diagnosis
biopsy confirms diagnosis
EPCA-2 (early prostate cancer antigen)

5

digital rectal exam DRE

1. Annually by age 50, earlier if higher risk
2. Allows for palpation of the posterior wall of the prostate gland
3. 40% of tumors cannot be felt on rectal exam

6

prostate specific antigen

–Blood Test used to detect a glycoprotein made by the prostate
–Introduction of PSA for screening between 1988 and 1992 led to dramatic increase in incidence rates
–Useful in monitoring response to therapy; can be elevated with non-cancerous conditions like prostatitis, BPH

7

transrectal ultrasound

–Assists with detection and biopsy of nonpalpable tumors

8

early prostate cancer antigen

More specific tumor marker for early prostate cancer

9

prostate cancer clinical manifestations

Early disease: asymptomatic
Later:
1. Sx of urinary obstruction: inability to urinate, difficulty starting or stopping slow, frequency, hematuria, nocturia, UTI
2. Pain in lower back, pelvis, upper thighs, hips
3. Malaise

10

prostate cancer staging

Stage A: confined to gland (microscopic)
Stage B: confined to gland (larger)
Stage C: Involves prostate capsule, urethra, bladder, pelvic lymph nodes, with increased serum acid phosphatase
Stage D: Metastases to bone, extra-pelvic lesions

11

prostate cancer management

watchful waiting in older men?
surgery is the standard treatment

12

prostate cancer surgery management

Cryosurgical Ablation: Cryoprobes positioned around prostate and liquid nitrogen freezes the gland; can be repeated
Laparoscopic Prostatectomy (most common)
Radical Prostatectomy: open procedure with incision

13

suprapubic approach

removes prostate from urethra by way of bladder

14

retropubic approach

Bladder retracted, prostate removed thru incision

15

perineal approach

1. Incision between rectum and scrotum
2. Perineal dressing
3. With radical perineal surgery, muscles, (pudendal nerve) nerves around rectal sheath can lead to greater problems with continence and impotence post-op

16

post op prostatectomy

–Retrograde Ejaculations: removal of tissue at bladder neck allows seminal fluid to travel up into bladder rather than down urethra
–ED (Erectile Dysfunction):
Temporary or permanent depending on damage to pudendal nerve
If temporary, function usually returns in 3-12 mos.

17

urinary incontinence teaching for prostate cancer

1. Standard post-op care (Cough & Deep Breathe, leg exercises (dorsiflexion, plantar flexion), etc.)
2. Teach care of urinary catheter and drainage bag-leg bag-discharged with catheter
3. Avoid straining, rectal temps and meds, enemas
4. May have drain (penrose or JP)

18

bilateral orchiectomy

removal of testicles
Palliative: performed in order to arrest disease by removing source of testosterone

19

chemo for prostate cancer

not proven for prostatic cancer

20

prostate cancer radiation

1. Used as an alternative curative treatment for locally contained tumors
2. As adjunct to radical prostatectomy when nodes or margins are positive
3. Use for palliation (bone metastasis)

21

prostate cancer radioactive seed implantation

1. Done on ambulatory basis
2. Effective for early stage prostate cancer
3. Well tolerated

22

prostate cancer hormonal therapy

–Decrease testosterone levels by:
1. Bilateral Orchiectomy
2. OR Estrogens (Diethystilbestrol) – Inhibit release of LH from pituitary gland
3. Gonadotropin- releasing hormone agonist: (Lupron) suppresses the release of LH by pituitary
4. Androgen blocking agent (Fluteamide) – blocks uptake of androgens at prostate cancer site
5. Degarelix: decreases levels of testosterone

23

prostate cancer prognosis

–Usually slow growing in “older” men (even stage C can have long survival 8-10 years)
–Can progress rapidly in younger men, higher levels of testosterone

24

prostate cancer prevention

–Secondary Prevention: Early Detection
–PSA at age 50 yrs. or age 45 yrs. if high risk
–DRE annually