PROSTATE CANCER

Mildred N. Pinque, RN, MN

Instructor
Anatomy of the male reproductive and
urinary systems, showing the prostate,
testicles, bladder, and other organs.
Prostate Gland and Functions
 Prostate cancer
• is a disease in which
malignant (cancer)
cells form in the
tissues of the prostate.
• Prostate cancer is most
common in older men.
• In the U.S., about 1 out of
5 men will
be diagnosed with
prostate cancer.
Some Facts About Prostate Cancer
• Prostate Cancer occurs primarily in older men. Nearly two-thirds of
men diagnosed with prostate cancer are 65 or older

• There are no consistent or noticeable symptoms of prostate cancer

while it is in the early stages.
 Pathophysiology – PROSTATE CA
Carcinogens/changes in normal semen-secreting
the structure of the cell prostate gland cells

Rate of cell division no longer equal to cell death

Uncontrolled tumor growth

Further mutations of a multitude of genes

Adenocarcinoma – glandular tumor

tumor may grow large tumor cells may

enough to invade develop the ability metastasizes to
nearby organs as the to travel the bones, lymph
seminal vesicles or bloodstream and nodes, rectum,
the rectum lymphatic system and bladder.
Clinical Manifestations
▪EARLY STAGE: rarely ▪Weight Loss
produces symptoms ▪ Back/Hip Pain
▪ Impotence ▪ Perineal and Rectal
▪ Blood in the urine and Discomfort
semen ▪ Anemia
▪ Painful ejaculations ▪Shortness of Breath
▪ Signs of Urinary Obstruction:-
Urinary Urgency, Frequency, ▪ Weakness
Nocturia, Dysuria, Decreased size ▪ Nausea
and force of urine stream
▪ Oliguria
Benign Prostatic Hyperplasia (BPH)
Tests used to diagnose prostate
cancer
• Physical exam and health history
• Digital rectal exam (DRE)
Tests used to diagnose prostate
cancer
Transrectal ultrasound

• Transrectal
ultrasound
Tests used to diagnose prostate
cancer

• Prostate-specific
antigen (PSA) test
Tests used to diagnose prostate
cancer

Transrectal biopsy
Grading of Prostate Cancer
• The grade of the prostate cancer is called
the Gleason score.
• The grade of the cancer describes how abnormal the
cancer cells look under a microscope and how
quickly the cancer is likely to grow and spread.
• A Gleason score of
• 6 is a low-grade cancer
• 7 is a medium-grade cancer
• 8, 9, or 10 is a high-grade cancer
Staging of Prostate Cancer
• The process used to find out if cancer has spread
within the prostate or to other parts of the body
• procedures also may be used in the staging process
• Bone scan
• MRI(magnetic resonance imaging)
• CT scan (CAT scan)
• Pelvic lymphadenectomy
• Seminal vesicle biopsy
Bone scan

• A procedure to check if there are

rapidly dividing cells, such as
cancer cells, in the bone. A very
small amount
of radioactive material
is injected into a vein and travels
through the bloodstream. The
radioactive material collects in
the bones with cancer and is
detected by a scanner
MRI (magnetic resonance imaging)
• uses a magnet, radio waves,
and a computer to make a
series of detailed pictures of
areas inside the body. This
procedure is also called
nuclear magnetic resonance
imaging (NMRI)
 CT scan (CAT scan)
• A procedure that makes a
series of detailed pictures of
areas inside the body, taken
from different angles..
A dye may be injected into a
vein or swallowed to help
the organs or tissues show up
more clearly.
• Pelvic lymphadenectomy
A surgical procedure to
remove the lymph nodes in
the pelvis.
A pathologist views the
tissue under a microscope
to look for cancer cells.
• Seminal vesicle biopsy: The
removal of fluid from
the seminal vesicles
(glands that
make semen) using a
needle. A pathologist
views the fluid under a
microscope to look for
cancer cells.
PSA level determination
• The PSA test
measures the level of
PSA in the blood. PSA
is a substance made
by the prostate that
may be found in an
increased amount in
the blood of men
who have prostate
cancer.
Metastatic Mechanism of Prostate Cancer

•Direct Spread
•Lymphatic Spread
•Hematogenous Spread.
Direct Spread
Lymphatic Spread
Hematogenous Spread
Factors Affecting Prognosis

• The prognosis and treatment options depend on the

following:
• The stage of the cancer
• The patient’s age
• Whether the cancer has just been diagnosed or
has recurred (come back).
Factors Affecting Treatment Options
• Whether the patient has other health problems
• The expected side effects of treatment
• Past treatment for prostate cancer
• The wishes of the patient
Stages 1 Prostate Cancer
• Stage I prostate cancer.
Cancer is found in the
prostate only. The cancer
is not felt during a digital
rectal exam and is found
by needle biopsy done for
high prostate-specific
antigen (PSA) level or in a
sample of tissue removed
during surgery for other
reasons.
• The PSA level is less than
Stages 2 Prostate Cancer

• In stage II, cancer is more

advanced than in stage I,
but has not spread outside
the prostate. Stage II is
divided into stages IIA, IIB,
and IIC.
Stage 2A Prostate Cancer
• Stage IIA prostate cancer. Cancer
is found in the prostate only.
Cancer is found in one-half or
less of one side of the prostate.
The prostate-specific antigen
(PSA) level is at least 10 but less
than 20
Stage 2B Prostate
Cancer
• Stage IIB prostate cancer.
Cancer is found in the
prostate only. Cancer is
found in one or both sides
of the prostate. The
prostate-specific antigen
level is less than 20
Stage 2C Prostate Cancer

• Stage IIC prostate cancer.

Cancer is found in the
prostate only. Cancer is
found in one or both sides
of the prostate. The
prostate-specific antigen
level is less than 20
Stage 3A Prostate Cancer
Stage 3B Prostate Cancer
Stage 3C Prostate Cancer
Stage 4A Prostate Cancer
Stage 4B Prostate Cancer
Treatment
• Surgery
• Radiation therapy
• Hormone therapy
• Chemotherapy
• Immunotherapy
• Bisphosphonate therapy
 Surgery

Radical prostatectomy
• A surgical procedure to
remove the prostate,
surrounding tissue
and seminal vesicles.
• Removal of nearby lymph
nodes may be done at the
same time.
Surgery: TURP
Transurethral resection of the
prostate (TURP)
• Tissue is removed from the
prostate using a
resectoscope (a thin, lighted
tube with a cutting tool at
the end) inserted through
the urethra.
• Prostate tissue that is
blocking the urethra is cut
away and removed through
the resectoscope
Surgery: Orchiectomy
• Surgical castration (bilateral orchiectomy, removal of one or both of
the testes), mainstay of hormonal treatment
• Bilateral orchiectomy decreases plasma testosterone levels
significantly (approximately 93% of circulating testosterone is of
testicular origin)
External Radiation Therapy
External Radiation Therapy
•Teletherapy (external-beam radiation therapy
[EBRT])
• prescribed a total dose over a certain time frame
(for example, 28 treatments over 5½ weeks).
• It is a treatment option for patients with low-risk
prostate cancer
Brachytherapy (Internal Radiation)
• implantation of interstitial radioactive seeds
• The surgeon uses ultrasound guidance to place 80 to 100 seeds
(depending on the prostate volume)
• patient returns home after the procedure: one day
• patient should avoid close contact with pregnant women and infants
for up to 2 months.
• include straining urine for seeds and using a condom during sexual
intercourse for 2 weeks after implantation to catch any seeds that
pass through the urethra..
Brachytherapy (Internal Radiation)
Hormone therapy
Chemotherapy
Immunotherapy
 Bisphosphonate therapy

• Bisphosphonate
drugs
• Clodronate
• zoledronate
Cryosurgery
• used to ablate prostate cancer in
patients who cannot tolerate
surgery
• recurrent prostate cancer.
• Transperineal probes are
inserted into the prostate under
ultrasound guidance to freeze
the tissue directly
Advanced Prostate Cancer
• Palliative measures are indicated
• Bone lesions that result from metastasis of prostate cancer can be
very painful and result in pathologic fractures.
• Opioid and nonopioid medications are used to control bone pain
Thank you…