WHAT IS PROSTATE CANCER?

The prostate is a small walnut shaped gland in the pelvis of men. It is located next to the bladder and
can be examined by getting a digital rectal exam.

Growths in the prostate can be benign (not cancerous) or malignant (cancerous).

Benign growths (like benign prostatic hyperplasia (BPH):

 Are rarely a threat to life

 Don't invade the tissues around them
 Don't spread to other parts of the body
 Can be removed and can grow back very slowly (but usually don't grow back)

Malignant growths (prostate cancer):

 May sometimes be a threat to life

 Can spread to nearby organs and tissues (such as the bladder or rectum)
 Can spread (metastasize) to other parts of the body (like lymph nodes or bone)
 Often can be removed but sometimes grow back

Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood
vessels or lymph nodes to reach other parts of the body. After spreading, cancer cells may attach to
other tissues and grow to form new tumors, causing damage where they land. (Prostate cancer may
return.)
When prostate cancer spreads from its original place to another part of the body, the new tumor has
the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if
prostate cancer spreads to the bones, the cancer cells in the bones are actually prostate cancer cells.
The disease is metastatic prostate cancer, not bone cancer. For that reason, it's treated as prostate
cancer in bone.

Symptoms

In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like
those of an enlarged prostate or BPH. Prostate cancer can also cause symptoms unrelated to BPH. If you
have urinary problems, talk with your healthcare provider about them.

Symptoms of prostate cancer can be:

 Dull pain in the lower pelvic area

 Frequent urinating
 Trouble urinating, pain, burning, or weak urine flow
 Blood in the urine (Hematuria)
 Painful ejaculation
 Pain in the lower back, hips or upper thighs
 Loss of appetite
 Loss of weight
 Bone pain

Causes

No one knows why or how prostate cancer starts. Autopsy studies show 1 in 3 men over the age of 50
have some cancer cells in the prostate. Eight out of ten "autopsy cancers" found are small, with tumors
that are not harmful.

Even though there is no known reason for prostate cancer, there are many risks associated with the
disease.

What Are The Risk Factors for Prostate Cancer?

Age

As men age, their risk of getting prostate cancer goes up. It is rarely found in men younger than age 40.
Damage to the genetic material (DNA) of prostate cells is more likely for men over the age of 55.
Damaged or abnormal prostate cells can begin to grow out of control and form tumors.
Age is a well-known risk factor for prostate cancer. But, smoking and being overweight are more closely
linked with dying from prostate cancer.

Ethnicity

African American men have, by far, the highest incidence of the disease. One in six African American
men will get prostate cancer. African American men are more likely to get prostate cancer at an earlier
age. They are also more like to have aggressive tumors that grow quickly, spread and cause death. The
reason why prostate cancer is more prevalent in African American men is unclear yet it may be due to
socioeconomic, environmental, diet or other factors. Other ethnicities, such as Hispanic and Asian men,
are less likely to get prostate cancer.

Family History

Men with a family history of prostate cancer also face a higher risk of also developing the disease. A man
is 2 to 3 times more likely to get prostate cancer if his father, brother or son had it. This risk increases
with the number of relatives diagnosed with prostate cancer. The age when a close relative was
diagnosed is also an important factor.

Smoking

Studies show prostate cancer risk may double for heavy smokers. Smoking is also linked to a higher risk
of dying from prostate cancer. However, within 10 years of quitting, your risk for prostate cancer goes
down to that of a non-smoker the same age.

World Area

Prostate cancer numbers and deaths vary around the world but are higher in North America and
Northern Europe. Higher rates may be due to better or more screening procedures, heredity, poor diets,
lack of exercise habits, and environmental exposures.

Diet

Diet and lifestyle may affect the risk of prostate cancer. It isn't clear exactly how. Your risk may be
higher if you eat more calories, animal fats, refined sugar and not enough fruits and vegetables. A lack of
exercise is also linked to poor outcomes. Obesity (or being very overweight) is known to increase a
man's risk of dying from prostate cancer. One way to decrease your risk is to lose weight, and keep it off.

Can Prostate Cancer Be Prevented?

Doing things that are "heart healthy", will also keep your prostate healthy. Eating right, exercising,
watching your weight and not smoking can be good for your health and help you avoid prostate cancer.

Some healthcare providers believe drugs like finasteride (Proscar ®) and dutasteride (Avodart ®) can
prevent prostate cancer. Others believe they only slow the development of prostate cancer. Studies do
show that men taking these drugs were less likely to be diagnosed with prostate cancer. Still, it is not
clear if these drugs are affective so you should talk to your doctor about the possible side effects.

Diagnosis

Screening

"Screening" means testing for a disease even if you have no symptoms. The prostate specific antigen
(PSA) blood test and digital rectal examination (DRE) are two tests that are used to screen for prostate
cancer. Both are used to detect cancer early. However, these tests are not perfect. Abnormal results
with either test may be due to benign prostatic enlargement (BPH) or infection, rather than cancer.

The two main types of screenings are:

o PSA Blood Test

The prostate-specific antigen (PSA) blood test is one way to screen for prostate cancer. This
blood test measures the level of PSA in the blood. PSA is a protein made only by the prostate
and prostate cancers. The test can be done in a lab, hospital or healthcare provider's office. Very
little PSA is found in the blood of a man with a healthy prostate. A low PSA is a sign of prostate
health. A rapid rise in PSA may be a sign that something is wrong. Prostate cancer is the most
serious cause of a high PSA result. Another reason for a high PSA can be benign (non-cancer)
enlargement of the prostate. Prostatitis, inflammation of the prostate, can also cause high PSA
results.

o DRE

The digital rectal examination (DRE) helps your doctor find prostate problems. For this exam, the
healthcare provider puts a lubricated gloved finger into the rectum. The man either bends over
or lies curled on his side on a table. During this test, the doctor feels for an abnormal shape or
thickness to the prostate. DRE is safe and easy to do. But the DRE by itself cannot detect early
cancer. It should be done with a PSA test.

 Prostate Cancer Biopsy

 If prostate cancer is suspected based on results of screening or symptoms, the actual diagnosis can
only be made by performing a prostate biopsy. A biopsy involves removing about 12 small core
samples of the prostate for histological examination. A core biopsy is the main method used.
Biopsies can sometimes miss a cancer, and if it is strongly suspected cancer is present after the
biopsy, a repeat biopsy may be considered or other lab tests carried out to confirm it. These tests
include:
 Prostate Health Index (PHI)
 4K Score Test
 PCA3 (Progensa)
 ExoDxProstate (IntelliScore)
 TMPRSS2-ERG
 ConfirmMDx

What are the benefits and risks of screening?

The PSA test and DRE are very important tools. They help to find prostate cancer early, before it
spreads. When found early, it can be treated early which helps stop or slow the spread of
cancer. This is likely to help some men live longer.

A risk of a PSA test is that it may miss detecting cancer (a "false negative"). Or, the test may be a
"false positive," suggesting something is wrong when you are actually healthy. A false positive
result may lead to a biopsy that isn't needed. The test might also detect very slow growing
cancer that will never cause problems if left untreated.

Who Should Get Screened?

Screening is recommended if you are a man:

 Between 55–69 years old

 African–American
 Have a family history of prostate cancer

Stages

How is Prostate Cancer Graded and Staged?

Grading (with the Gleason Score) and staging defines the progress of cancer and whether it has spread:

 Grading

When prostate cancer cells are found in tissue from the core biopsies, the pathologist "grades"
it. The grade is a measure of how quickly the cells are likely to grow and spread (how aggressive
it is).
 The most common grading system is called the Gleason grading system. With this system, each
tissue piece is given a grade between three (3) and five (5). In the past, we assigned scores of
one (1) and two (2). A grade of less than three (3) means the tissue is close to normal. A grade of
three (3) suggests a slow growing tumor. A high grade of five (5) indicates a highly aggressive,
high-risk form of prostate cancer.

The Gleason system then develops a "score" by combing the two most common grades found in
biopsy samples. For example, a score of grades 3 + 3 = 6 suggests a slow growing cancer. The
highest score of grades 5 + 5 = 10 means that cancer is present and extremely aggressive.

The Gleason score will help your doctor understand if the cancer is as a low-, intermediate- or
high-risk disease. Generally, Gleason scores of 6 are treated as low risk cancers. Gleason scores
of around 7 are treated as intermediate/mid-level cancers. Gleason scores of 8 and above are
treated as high-risk cancers.

If you are diagnosed with prostate cancer, ask about your Gleason score and how it impacts
your treatment decisions.

 Staging

Tumor stage is also measured. Staging describes where the cancer is within the prostate, how
extensive it is, and if it has spread to other parts of the body. One can have low stage cancer
that is very high risk. Staging the cancer is done by DRE and special imaging studies.

The system used for tumor staging is the TNM system. TNM stands for Tumor, Nodes and
Metastasis. The "T" stage is found by DRE and other imaging tests such as an ultrasound, CT
scan, MRI or bone scan. The imaging tests show if and where the cancer has spread, for
example: to lymph nodes or bone.

These staging imaging tests are generally done for men with a Gleason grade of 7 or higher and
a PSA higher than 10. Sometimes follow-up images are needed to evaluate changes seen on the
bone scan.
What Are The Survival Rates For Prostate Cancer?

Many men with prostate cancer will not die from it; they will die from other causes. For men who are
diagnosed, it is better if it is caught early.

Survival rates for men with prostate cancer have increased over the years, thanks to better screening
and treatment options. Today, 99% of men with prostate cancer will live for at least 5 years after
diagnosis. Many men having treatment are cured. Most prostate cancer is slow-growing and takes many
years to progress. One out of three men will survive after five years, even if the cancer has spread to
other parts of the body

Treatment

Some cancers grow so slowly that treatment may not be needed at all. Others grow fast and are life-
threatening so treatment is usually necessary. Deciding what treatment you should get can be complex.
Talk with your healthcare team about your options. Your treatment plan will depend on:

 The stage and grade of the cancer (Gleason score and TNM stage)
 Your risk category (whether the cancer is low, intermediate or high risk)
 Your age and health
 Your preferences with respect to side effects, long-term effects and treatment goals

Surveillance

 Active Surveillance - It monitors the cancer growth with regular PSA tests, DREs and periodic
biopsies. best if you have a small, slow growing (low-risk) cancer. It is good for men who do not
have symptoms. If you want to avoid sexual, urinary or bowel side effects for as long as possible,
this may be the treatment for you. Active surveillance allows men to maintain their quality of
life longer without risking the success of treatment (if and when it's needed). mainly used to
delay or avoid aggressive therapy
 Watchful Waiting - Watchful waiting is a less involved system of monitoring the cancer without
treating it. It does not involve regular biopsies or other active surveillance tools. It is best for
men with prostate cancer who do not want or cannot have therapy

Localized Therapy

 Surgery
There are three types of radical prostatectomy surgery:

o Robotic Assisted Laparoscopic Radical Prostatectomy (RALP)

Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) is the most
common type of prostate cancer surgery done today. The surgeon is assisted
 with a robotic system that holds and guides the laparoscopic surgical tools and
camera. It also allows the prostate to be removed through tiny ports placed in
your belly. In experienced hands, RALP and retropubic prostatectomy (see
below) have similar outcomes. There is also less blood loss with robotic surgery
than other methods.

o Retropubic Open Radical Prostatectomy

For this procedure, your surgeon will make a cut (incision) in your lower belly
and remove the prostate through this opening. The entire prostate gland is
removed. Your surgeon can assess the prostate gland and surrounding tissue at
the same time, while reducing injury to nearby organs. There can be enough
blood loss to need a transfusion.

o Laparoscopic Radical Prostatectomy

This surgery uses small cuts in the abdomen to remove the prostate with small
tools and a camera. This surgery has mostly been replaced with robotic assisted
laparoscopic surgery.
 Radiation Therapy - uses high-energy rays to kill or slow the growth of cancer cells. Radiation
can be used as the primary treatment for prostate cancer (in place of surgery). It can also be
used after surgery if the cancer is not fully removed or if it returns. There are two primary kinds
of radiation therapy used for prostate cancer:
External beam radiation therapy
Brachytherapy (internal radiation)
 Cryotherapy - is the controlled freezing of the prostate gland. The freezing destroys cancer cells.
 Focal Therapy – types: High-intensity focused ultrasound (HIFU), Focal cryoablation, irreversible
electroporation

Systemic Therapy

 Hormonal Therapy - is also known as androgen deprivation therapy (ADT). It uses drugs to block
or lower testosterone and other male sex hormones that fuel cancer.
 Chemotherapy - uses drugs to destroy cancer cells anywhere in the body. It is used for advanced
stages of prostate cancer.
 Immunotherapy - stimulates your body's immune system to find and attack cancer cells.

IMPLICATIONS FOR NURSING PRACTICE

Nursing care focuses on providing patients with accurate information to make informed
decisions regarding treatment for early stage disease, on promoting comfort, and on preventing
and managing treatment and disease-related complications. Nursing diagnoses include
knowledge deficit; altered sexual patterns, body image disturbance, altered urinary elimination,
diarrhea, impaired skin integrity, and pain, fatigue, bleeding, and infection, all of which are
related to surgery, pathologic fractures, spinal cord compression, and edema of the
scrotum/lower extremities

References:

https://www.urologyhealth.org/urologic-conditions/prostate-cancer

https://pubmed.ncbi.nlm.nih.gov/7816678/